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Liver & GIT

4 out of 4

Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension? (AIIMS MAY 08)

A Chronic liver failure

B Ascites

C Upper gastrointestinal bleeding

D Encephalopathy

Ans. C Upper gastrointestinal bleeding

i. Non cirrhotic Hypertension can be due to non cirrhotic portal fibrosis (NCPF) or Extra hepatic portal venous obstruction (EHPVO)

ii. It is also called: Idiopathic portal hypertension

iii. Its incidence is very high in India accounts for 15% to 18% of all patients with portal hypertension.

iv. Aetiology:

Infection It was suggested that E. coli can cause NCPF

Exposure to chemicals Chronic ingestion of (1) Arsenic (2) Vinyl Chloride toxicity (3) Copper

Extra Edge: (Arsenic also causes skin Ca, lung Ca, hepatic angiosarcoma)

Clinical features:

1. Massive hematemesis. (M/C presentation)

2. Rarely patient develop encephalopathy.

3. Ascites is uncommon

4. Splenomegaly is present

5. Jaundice and signs of liver cell failure are uncommon.


i. Normal liver function test ii. Normal PT iii. S. Proteins normal iv. Portography:

1. Weeping willow appearance – sudden cut off of peripheral portal vein branches.

2. Tree in winter appearance– filling of a large number of collaterals with gross distortion of intrahepatic pattern.

3. Splenic vein is dilated and tortuous.


1) Treatment of choice is endoscopic sclero therapy.

DD is EHPO (Extra hepatic portal venous obstruction)

Comparison between NCPF and EHPVO

1. Similarities between the two conditions

a. Massive variceal bleeding b. Moderate to massive splenomegaly

c. Normal liver on histology d. Absence of Ascites e. Normal liver function

2. Difference between these two conditions

a. Age of presentation

. EHPVO Children

. NCPF Young adult

b. Site of obstruction in the portal venous system

EHPVO Main and 1st order branches of portal vein

NCPF Smaller 3rd and 4th order branches of portal vein are involved.

c. Splenomegaly – more common in NCPF than EHPVO