A young boy, Rahul presents with massive hemetemesis. He had fever for 15 days few days back which was treated with few drugs. Clinical examination reveal moderate splenomegaly). No other history is positive) Probable diagnosis is:

Answer is D (Oesophageal varices) Oesophageal variceal bleeding secondary to poal hypeension .should always be the initial diagnosis in a young patient presenting with massive hematemesis and a moderate to large splenomegaly' Features in our of oesophageal varices: Most common presentation of oesophageal varices is G.I. bleed, which may be 'massive'. - Massive hematemesis in children is almost always due to variceal bleed - Shwaz - Gastrointestinal bleed in peptic ulcer disease usually occurs in persons who are > 60 years old i.e. (it ceainly is an uncommon presentation in a young boy) - Harrison - Erosive drug induced gastritis is usually superficial therefore hemodynamically significant 'massive' bleeding is rare Patients presents with moderate splenomegaly which is an impoant pointer towards presence of poal hypeension. - Absence of any significant history of altered liver function in the presence of poal hypeension could well be attributed to an extrahepatic causes of poal hypeension.