A 50 year old man has presented with one episode of hematemesis. On vital examination HR= 110/min with BP of 110/80 mmHg. Systemic examination shows enlarged spleen with dilated touous veins around the umbilicus. First differential diagnosis is?

**Core Concept**
The patient's presentation with hematemesis, tachycardia, and an enlarged spleen with dilated tortuous veins around the umbilicus is suggestive of portal hypertension. This condition occurs due to increased pressure in the portal vein system, often as a result of liver disease or portal vein thrombosis.

**Why the Correct Answer is Right**
The patient's symptoms and signs are consistent with a diagnosis of cirrhosis, which is a common cause of portal hypertension. Cirrhosis leads to increased resistance to blood flow through the liver, causing portal hypertension. This can result in the development of varices, which are dilated veins that can bleed easily, leading to hematemesis. The dilated tortuous veins around the umbilicus (caput medusae) are a classic sign of portal hypertension.

**Why Each Wrong Option is Incorrect**
**Option A:** This option may be considered if the patient had a history of chronic pancreatitis, but the presence of an enlarged spleen and dilated tortuous veins around the umbilicus makes this less likely.
**Option B:** While splenic vein thrombosis can cause portal hypertension, the patient's presentation and history do not strongly suggest this diagnosis.
**Option C:** This option is unlikely as the patient's presentation does not suggest a primary gastrointestinal malignancy.

**Clinical Pearl / High-Yield Fact**
In a patient with portal hypertension, the presence of caput medusae (dilated tortuous veins around the umbilicus) is a strong indicator of cirrhosis.

**Correct Answer:** D. Cirrhosis.

✓ Correct Answer: B. Non cirrhotic poal fibrosis