Boy with hematemesis, melena and mild splenomegaly – Paediatrics MCQ

A 12 year old Boy with hematemesis, melena and mild splenomegaly presented to the paediatrics OPD. Examination revealed absence of jaundice / ascites. Most probable diagnosis is?

A. Extrahepatic Portal Venous Obstruction (EHPVO)
B. Cirrhosis
C. Non Cirrhotic Portal Fibrosis (NCPF)
D. Malaria with disseminated intravascular coagulation

Correct answer : A. Extrahepatic Portal Venous Obstruction (EHPVO)

  • Hematemesis, melena and splenomegaly are suggestive of a diagnosis of portal hypertension
  • The first three options can cause portal hypertension
  • But considering the age and sex of the child, Extrahepatic Portal Venous Obstruction (EHPVO) is the most probable diagnosis
  • Non Cirrhotic Portal Fibrosis (NCPF) is usually seen in adult females in the third or fourth decade
  • Cirrhosis is not very common in children, and it is usually accompanied by jaundice / ascites

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