<prompt> A young boy presented with severe hematemesis. 0E there was no hepatomegaly, Mild splenomegaly is present. Endoscopy shows esophageal varices. The most probable diagnosis -Veno occlusive diseaseBudd chiari syndromeCirrhosis liverNon cirrhotic poal fibrosis  <response>: Ans. is d i.e., Non Cirrhotic poal fibrosisSplenomegaly, variceal bleeding in the absence of hepatomegaly suggest the diagnosis of non cirrhotic poal fibrosis. Non Cirrhotic Poal Fibrosis o Its incidence is very high in India accounts for 15 to 18 of all patients with poal hypeension. Aetiology :i Infection --- It was suggested that E.coli can cause NCPFii Exposure to chemicals -- Chronic ingestion ofArsenic is incriminated in causing NCPF.Vinyl Chloride toxicity can also cause NCPFo Clinical features :Symptoms :Patients are usually young in 3rd or 4th decade of life.Gastrointestinal haemorrhage is the most common presenting symptom seen in 60-90 of patients.Lump in the left side of Abdomen dt enlargement of spleenJaundice Ascites uncommon and if they do occur it is for a sho period of time.SignsSplenomegaly usually massiveLiver usually normal in sizeSometimes mild ascites can be seen.Endoscopy :Oesophageal varices are detected in over 90 of patientsRectal varices in 70 of patients. 