from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from io import BytesIO

# ── Colour palette ──────────────────────────────────────────────────────────
DARK_BLUE   = RGBColor(0x1A, 0x37, 0x6C)   # navy
MID_BLUE    = RGBColor(0x1E, 0x6A, 0xA5)   # medium blue
ACCENT_TEAL = RGBColor(0x00, 0x8B, 0x8B)   # teal
LIGHT_BG    = RGBColor(0xF0, 0xF6, 0xFF)   # very light blue-white
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GREY  = RGBColor(0xE8, 0xEE, 0xF6)
DARK_TEXT   = RGBColor(0x1A, 0x1A, 0x2E)
ACCENT_RED  = RGBColor(0xC0, 0x39, 0x2B)
ACCENT_GREEN= RGBColor(0x1A, 0x7A, 0x4A)
ORANGE      = RGBColor(0xE6, 0x7E, 0x22)

def add_rect(slide, x, y, w, h, fill=None, line_color=None, line_width=None):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.line.fill.background()
    if fill:
        shape.fill.solid()
        shape.fill.fore_color.rgb = fill
    else:
        shape.fill.background()
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = Pt(line_width or 1)
    else:
        shape.line.fill.background()
    return shape

def add_textbox(slide, x, y, w, h, text, font_size=12, bold=False, color=DARK_TEXT,
                align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(2)
    tf.margin_right = Pt(2)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb

def add_multiline_textbox(slide, x, y, w, h, lines, font_size=11, bold=False,
                          color=DARK_TEXT, align=PP_ALIGN.LEFT, line_spacing=None):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    for i, line in enumerate(lines):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.alignment = align
        if line_spacing:
            p.line_spacing = Pt(line_spacing)
        run = p.add_run()
        if isinstance(line, dict):
            run.text = line['text']
            run.font.size = Pt(line.get('size', font_size))
            run.font.bold = line.get('bold', bold)
            run.font.color.rgb = line.get('color', color)
            run.font.italic = line.get('italic', False)
        else:
            run.text = line
            run.font.size = Pt(font_size)
            run.font.bold = bold
            run.font.color.rgb = color
        run.font.name = "Calibri"
    return tb

def add_header_bar(slide, title, subtitle=None):
    """Add gradient-style header bar to slide"""
    add_rect(slide, 0, 0, 13.333, 1.4, fill=DARK_BLUE)
    add_rect(slide, 0, 1.4, 13.333, 0.06, fill=ACCENT_TEAL)
    add_textbox(slide, 0.3, 0.1, 12.7, 0.85, title,
                font_size=28, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_textbox(slide, 0.3, 0.9, 12.7, 0.5, subtitle,
                    font_size=13, bold=False, color=LIGHT_BG, italic=True)

def add_slide_number(slide, num):
    add_textbox(slide, 12.5, 7.2, 0.8, 0.3, str(num),
                font_size=9, color=RGBColor(0xAA, 0xAA, 0xAA), align=PP_ALIGN.RIGHT)

def add_footer(slide, text="Inflammatory Bowel Disease | Medical Education"):
    add_rect(slide, 0, 7.3, 13.333, 0.2, fill=DARK_BLUE)
    add_textbox(slide, 0.3, 7.3, 10, 0.2, text,
                font_size=7, color=LIGHT_BG, align=PP_ALIGN.LEFT)

def bullet_lines(items, indent="  •  "):
    return [f"{indent}{item}" for item in items]

# ─────────────────────────────────────────────────────────────────────────────
prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=DARK_BLUE)
add_rect(s, 0, 5.8, 13.333, 1.7, fill=MID_BLUE)
add_rect(s, 0, 3.3, 13.333, 0.08, fill=ACCENT_TEAL)
# decorative circles
for cx, cy, cw in [(11.5,0.5,2.5),(10.2,5.5,1.8),(1.0,6.5,1.2)]:
    c = s.shapes.add_shape(9, Inches(cx), Inches(cy), Inches(cw), Inches(cw))
    c.fill.solid(); c.fill.fore_color.rgb = MID_BLUE
    c.line.fill.background()

add_textbox(s, 1.0, 1.2, 11.0, 0.8, "INFLAMMATORY BOWEL DISEASE",
            font_size=13, bold=True, color=ACCENT_TEAL, align=PP_ALIGN.CENTER)
add_textbox(s, 0.8, 1.9, 11.5, 1.3,
            "A Comprehensive Clinical Overview",
            font_size=38, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_textbox(s, 1.0, 3.05, 11.0, 0.5,
            "Crohn's Disease  •  Ulcerative Colitis  •  Indeterminate Colitis",
            font_size=16, bold=False, color=LIGHT_BG, align=PP_ALIGN.CENTER, italic=True)
add_textbox(s, 1.0, 5.9, 11.0, 0.5,
            "Based on Sleisenger & Fordtran's GI & Liver Disease  |  Goldman-Cecil Medicine  |  Harrison's Principles",
            font_size=10, bold=False, color=LIGHT_BG, align=PP_ALIGN.CENTER)
add_textbox(s, 1.0, 6.4, 11.0, 0.5,
            "July 2026",
            font_size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — TABLE OF CONTENTS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Table of Contents")
add_footer(s); add_slide_number(s, 2)

toc_items = [
    ("01", "Definition & Overview"),
    ("02", "Epidemiology & Risk Factors"),
    ("03", "Pathophysiology & Immunology"),
    ("04", "Types of IBD: Crohn's vs UC"),
    ("05", "Clinical Manifestations"),
    ("06", "Extraintestinal Manifestations"),
    ("07", "Diagnosis & Investigations"),
    ("08", "Endoscopic & Histological Features"),
    ("09", "Disease Activity Scoring"),
    ("10", "Medical Management"),
    ("11", "Biologic & Targeted Therapies"),
    ("12", "Surgical Management"),
    ("13", "Complications"),
    ("14", "IBD & Colorectal Cancer"),
    ("15", "Special Populations"),
    ("16", "Monitoring & Follow-up"),
    ("17", "Emerging Therapies"),
    ("18", "Key Takeaways"),
]
cols = [toc_items[:9], toc_items[9:]]
for col_i, col in enumerate(cols):
    x_base = 0.5 + col_i * 6.5
    for row_i, (num, title) in enumerate(col):
        y = 1.6 + row_i * 0.56
        add_rect(s, x_base, y, 0.55, 0.38, fill=MID_BLUE)
        add_textbox(s, x_base, y, 0.55, 0.38, num,
                    font_size=9, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
        add_textbox(s, x_base + 0.6, y, 5.6, 0.38, title,
                    font_size=12, bold=False, color=DARK_TEXT)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — DEFINITION & OVERVIEW
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Definition & Overview", "What is Inflammatory Bowel Disease?")
add_footer(s); add_slide_number(s, 3)

add_rect(s, 0.4, 1.6, 8.2, 5.5, fill=WHITE, line_color=RGBColor(0xCC,0xDD,0xEE), line_width=1)
add_multiline_textbox(s, 0.5, 1.65, 8.0, 5.3, [
    {"text":"DEFINITION", "size":13, "bold":True, "color":DARK_BLUE},
    {"text":" "},
    {"text":"IBD is a chronic, relapsing and remitting inflammatory disease of the gastrointestinal tract characterised by an inappropriate immune response to gut microbiota in genetically susceptible individuals.", "size":12},
    {"text":" "},
    {"text":"KEY FEATURES", "size":13, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Chronic inflammation — can last years to decades"},
    {"text":"  •  Relapsing-remitting course — flares interspersed with remissions"},
    {"text":"  •  Two main entities: Crohn's Disease (CD) and Ulcerative Colitis (UC)"},
    {"text":"  •  'Indeterminate colitis' when features overlap (~10% of cases)"},
    {"text":"  •  Not the same as Irritable Bowel Syndrome (IBS) — IBD has structural inflammation"},
    {"text":" "},
    {"text":"SCOPE", "size":13, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Affects both the GI tract and multiple organ systems"},
    {"text":"  •  Significant morbidity, reduced quality of life, risk of cancer"},
], font_size=12, color=DARK_TEXT, line_spacing=16)

add_rect(s, 9.0, 1.6, 4.0, 2.4, fill=DARK_BLUE)
add_multiline_textbox(s, 9.1, 1.65, 3.8, 2.3, [
    {"text":"IBD vs IBS", "size":14, "bold":True, "color":WHITE},
    {"text":" "},
    {"text":"IBD: Organic inflammation, endoscopically visible, biomarkers elevated", "color":LIGHT_BG, "size":11},
    {"text":" "},
    {"text":"IBS: Functional disorder, no structural change, normal investigations", "color":LIGHT_BG, "size":11},
], color=WHITE)

add_rect(s, 9.0, 4.15, 4.0, 2.95, fill=MID_BLUE)
add_multiline_textbox(s, 9.1, 4.2, 3.8, 2.85, [
    {"text":"Incidence", "size":14, "bold":True, "color":WHITE},
    {"text":" "},
    {"text":"CD: 3–20 per 100,000/yr (Western)", "color":LIGHT_BG, "size":11},
    {"text":"UC: 2–25 per 100,000/yr (Western)", "color":LIGHT_BG, "size":11},
    {"text":" "},
    {"text":"Rising incidence globally, including Asia, Africa, South America", "color":LIGHT_BG, "size":11},
    {"text":" "},
    {"text":"Peak onset: 15–35 yrs (bimodal distribution)", "color":LIGHT_BG, "size":11},
], color=WHITE)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — EPIDEMIOLOGY & RISK FACTORS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Epidemiology & Risk Factors")
add_footer(s); add_slide_number(s, 4)

add_rect(s, 0.4, 1.6, 6.0, 5.5, fill=WHITE, line_color=RGBColor(0xCC,0xDD,0xEE), line_width=1)
add_multiline_textbox(s, 0.55, 1.65, 5.8, 5.3, [
    {"text":"EPIDEMIOLOGICAL FACTS", "size":13, "bold":True, "color":DARK_BLUE},
    {"text":" "},
    {"text":"  •  Crohn's Disease (CD): F:M ratio = 1.2:1", "size":11},
    {"text":"  •  Ulcerative Colitis (UC): Equal sex distribution (1:1)", "size":11},
    {"text":"  •  Bimodal age peaks: 15–30 yrs and 50–70 yrs", "size":11},
    {"text":"  •  Highest prevalence in North America & Northern Europe", "size":11},
    {"text":"  •  Incidence increasing in newly industrialised countries (Asia, Middle East)", "size":11},
    {"text":"  •  Jews of Ashkenazi descent: 3–5× higher risk vs general population", "size":11},
    {"text":" "},
    {"text":"GENETIC RISK FACTORS", "size":13, "bold":True, "color":DARK_BLUE},
    {"text":" "},
    {"text":"  •  NOD2/CARD15 mutations — most replicated CD gene", "size":11},
    {"text":"  •  HLA-B27 — ankylosing spondylitis overlap", "size":11},
    {"text":"  •  >240 susceptibility loci identified via GWAS", "size":11},
    {"text":"  •  First-degree relatives: 5–20× increased risk", "size":11},
    {"text":"  •  Concordance: 50–60% in identical twins (CD)", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=16)

add_rect(s, 6.7, 1.6, 6.3, 5.5, fill=WHITE, line_color=RGBColor(0xCC,0xDD,0xEE), line_width=1)
env_factors = [
    ("ENVIRONMENTAL TRIGGERS", None, DARK_BLUE, True, 13),
    (" ", None, DARK_TEXT, False, 8),
    ("  Smoking", None, DARK_TEXT, True, 12),
    ("  •  Increases CD risk; protective in UC", None, DARK_TEXT, False, 11),
    (" ", None, DARK_TEXT, False, 8),
    ("  Diet & Microbiome", None, DARK_TEXT, True, 12),
    ("  •  Western diet (high fat, low fibre) increases risk", None, DARK_TEXT, False, 11),
    ("  •  Gut dysbiosis — reduced Firmicutes, increased Proteobacteria", None, DARK_TEXT, False, 11),
    (" ", None, DARK_TEXT, False, 8),
    ("  Hygiene Hypothesis", None, DARK_TEXT, True, 12),
    ("  •  Reduced childhood infections → aberrant immune maturation", None, DARK_TEXT, False, 11),
    (" ", None, DARK_TEXT, False, 8),
    ("  Other Factors", None, DARK_TEXT, True, 12),
    ("  •  NSAIDs may precipitate flares", None, DARK_TEXT, False, 11),
    ("  •  Oral contraceptives: modest increased CD risk", None, DARK_TEXT, False, 11),
    ("  •  Appendectomy: protective in UC, risk factor in CD", None, DARK_TEXT, False, 11),
    ("  •  Stress — can trigger relapse", None, DARK_TEXT, False, 11),
]
lines = []
for item in env_factors:
    lines.append({"text": item[0], "color": item[2], "bold": item[3], "size": item[4]})
add_multiline_textbox(s, 6.85, 1.65, 6.1, 5.3, lines, font_size=11, color=DARK_TEXT, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — PATHOPHYSIOLOGY
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Pathophysiology & Immunology", "The interplay of genetics, microbiome, immune dysregulation, and environment")
add_footer(s); add_slide_number(s, 5)

# 3 boxes
boxes = [
    (0.3, "GENETIC SUSCEPTIBILITY", [
        "•  NOD2/CARD15 — bacterial recognition defect",
        "•  ATG16L1 — impaired autophagy",
        "•  IL23R variants — Th17 pathway dysregulation",
        "•  IRGM — mitophagy and bacterial clearance",
        "•  Epithelial barrier gene defects",
    ], MID_BLUE),
    (4.6, "IMMUNE DYSREGULATION", [
        "•  Th1 dominance in Crohn's (TNF-α, IFN-γ, IL-12)",
        "•  Th2 dominance in UC (IL-4, IL-5, IL-13)",
        "•  Th17 pathway (IL-17, IL-23) — amplifies both",
        "•  Deficient regulatory T-cell (Treg) response",
        "•  Activated macrophages release pro-inflammatory cytokines",
        "•  Loss of mucosal tolerance to commensal bacteria",
    ], ACCENT_TEAL),
    (8.9, "GUT MICROBIOME", [
        "•  Dysbiosis: disrupted microbial diversity",
        "•  Reduced Firmicutes (Faecalibacterium prausnitzii)",
        "•  Increased E. coli, Fusobacterium",
        "•  Impaired short-chain fatty acid production",
        "•  Enteroadherent-invasive E. coli (AIEC) in CD",
        "•  Leaky gut → bacterial translocation",
    ], DARK_BLUE),
]
for (x_pos, title, points, col) in boxes:
    add_rect(s, x_pos, 1.7, 4.0, 5.4, fill=col)
    add_textbox(s, x_pos+0.1, 1.75, 3.8, 0.45, title, font_size=11, bold=True, color=WHITE)
    add_rect(s, x_pos, 2.2, 4.0, 4.9, fill=WHITE)
    add_multiline_textbox(s, x_pos+0.1, 2.25, 3.8, 4.8,
                          [{"text": p, "size":11, "color":DARK_TEXT} for p in points],
                          font_size=11, line_spacing=18)

# Arrow label
add_textbox(s, 0.3, 7.1, 12.7, 0.3,
            "Genetic susceptibility + microbial dysbiosis + aberrant immune activation → uncontrolled mucosal inflammation → tissue destruction",
            font_size=9, italic=True, color=DARK_BLUE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — CD vs UC COMPARISON
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Crohn's Disease vs Ulcerative Colitis", "Key distinguishing features")
add_footer(s); add_slide_number(s, 6)

# Table header
add_rect(s, 0.3, 1.7, 4.5, 0.45, fill=LIGHT_GREY)
add_rect(s, 4.8, 1.7, 4.0, 0.45, fill=MID_BLUE)
add_rect(s, 8.85, 1.7, 4.1, 0.45, fill=ACCENT_TEAL)
add_textbox(s, 0.3, 1.7, 4.5, 0.45, "CHARACTERISTIC", font_size=11, bold=True, color=DARK_BLUE, align=PP_ALIGN.CENTER)
add_textbox(s, 4.8, 1.7, 4.0, 0.45, "CROHN'S DISEASE", font_size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_textbox(s, 8.85, 1.7, 4.1, 0.45, "ULCERATIVE COLITIS", font_size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows = [
    ("GI Tract Involvement", "Esophagus to anus (any segment)", "Colon and rectum only"),
    ("Distribution", "Skip lesions (patchy)", "Continuous from rectum"),
    ("Inflammation Depth", "Transmural (full thickness)", "Mucosal / submucosal only"),
    ("Ulcer Type", "Discrete, deep, linear", "Superficial, continuous"),
    ("Fistulas", "Common (+)", "Rare (–)"),
    ("Strictures", "Common (+)", "Rare (–)"),
    ("Perianal Disease", "Common (+)", "Very rare"),
    ("Granulomas", "Non-caseating (~50%)", "Absent"),
    ("Smoking Effect", "Worsens disease", "Protective (paradoxically)"),
    ("CRC Risk", "4–20× general population", "Begins after 7–10 yrs disease"),
    ("Surgery Outcome", "Not curative", "Proctocolectomy is curative"),
]
for i, (char, cd, uc) in enumerate(rows):
    y = 2.2 + i * 0.44
    bg = WHITE if i % 2 == 0 else LIGHT_GREY
    add_rect(s, 0.3, y, 4.5, 0.44, fill=bg)
    add_rect(s, 4.8, y, 4.0, 0.44, fill=RGBColor(0xE8, 0xF4, 0xFF) if i%2==0 else WHITE)
    add_rect(s, 8.85, y, 4.1, 0.44, fill=RGBColor(0xE0, 0xF5, 0xF5) if i%2==0 else WHITE)
    add_textbox(s, 0.35, y+0.04, 4.4, 0.38, char, font_size=10, bold=True, color=DARK_TEXT)
    add_textbox(s, 4.85, y+0.04, 3.9, 0.38, cd, font_size=10, color=DARK_TEXT)
    add_textbox(s, 8.9, y+0.04, 4.0, 0.38, uc, font_size=10, color=DARK_TEXT)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — CLINICAL MANIFESTATIONS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Clinical Manifestations")
add_footer(s); add_slide_number(s, 7)

add_rect(s, 0.3, 1.7, 6.1, 5.5, fill=MID_BLUE)
add_textbox(s, 0.4, 1.75, 5.9, 0.45, "CROHN'S DISEASE", font_size=14, bold=True, color=WHITE)
add_rect(s, 0.3, 2.2, 6.1, 5.0, fill=WHITE)
add_multiline_textbox(s, 0.45, 2.25, 5.9, 4.9, [
    {"text":"Terminal ileum affected in ~70% of patients", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"  •  Ileocolonic disease (40%), ileal only (30%)", "size":11},
    {"text":" "},
    {"text":"Common Symptoms:", "size":11, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Abdominal pain (RLQ — mimics appendicitis)", "size":11},
    {"text":"  •  Diarrhea (often non-bloody)", "size":11},
    {"text":"  •  Hematochezia (less frequent than UC)", "size":11},
    {"text":"  •  Fatigue, weight loss, fever", "size":11},
    {"text":"  •  Nausea/vomiting (obstructive symptoms)", "size":11},
    {"text":" "},
    {"text":"Less Common:", "size":11, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Upper GI involvement (<5%): dysphagia, epigastric pain", "size":11},
    {"text":"  •  Perianal fistulas, fissures, skin tags", "size":11},
    {"text":"  •  Oral aphthous ulcers", "size":11},
    {"text":"  •  Abdominal mass (RLQ) in fibrostenotic disease", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

add_rect(s, 6.9, 1.7, 6.1, 5.5, fill=ACCENT_TEAL)
add_textbox(s, 7.0, 1.75, 5.9, 0.45, "ULCERATIVE COLITIS", font_size=14, bold=True, color=WHITE)
add_rect(s, 6.9, 2.2, 6.1, 5.0, fill=WHITE)
add_multiline_textbox(s, 7.05, 2.25, 5.9, 4.9, [
    {"text":"Starts in rectum; extends proximally", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"  •  Proctosigmoiditis (44–49%), pancolitis (14–37%)", "size":11},
    {"text":" "},
    {"text":"Cardinal Symptoms:", "size":11, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Bloody diarrhea ± mucus (hallmark)", "size":11},
    {"text":"  •  Tenesmus (urge to defecate)", "size":11},
    {"text":"  •  Urgency, crampy abdominal pain", "size":11},
    {"text":"  •  Hematochezia", "size":11},
    {"text":" "},
    {"text":"Severe Disease:", "size":11, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Weight loss, fever (>37.5°C)", "size":11},
    {"text":"  •  Nausea/vomiting, peripheral edema (hypoalbuminaemia)", "size":11},
    {"text":"  •  Anaemia (fatigue, pallor)", "size":11},
    {"text":" "},
    {"text":"Proctitis presentation:", "size":11, "bold":True, "color":DARK_BLUE},
    {"text":"  •  Constipation despite rectal urgency", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — EXTRAINTESTINAL MANIFESTATIONS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Extraintestinal Manifestations (EIMs)", "Systemic involvement in IBD — affects up to 40% of patients")
add_footer(s); add_slide_number(s, 8)

systems = [
    ("MUSCULOSKELETAL\n(Most common — 10–20%)", [
        "Peripheral arthritis / arthralgia",
        "Ankylosing spondylitis",
        "Sacroiliitis",
        "Clubbing",
        "Osteoporosis (steroid-related)",
    ], MID_BLUE, 0.3, 1.7),
    ("DERMATOLOGICAL\n(Up to 15%)", [
        "Erythema nodosum (10–15%)",
        "Pyoderma gangrenosum (1–2%)",
        "Aphthous stomatitis",
        "Sweet's syndrome",
        "Psoriasis",
    ], ACCENT_RED, 3.8, 1.7),
    ("OCULAR\n(5–15%)", [
        "Uveitis / iritis",
        "Episcleritis",
        "Scleritis",
        "Cataracts (steroid-induced)",
    ], ACCENT_TEAL, 7.3, 1.7),
    ("HEPATOBILIARY\n(2–7.5%)", [
        "Primary sclerosing cholangitis (UC>>CD)",
        "Autoimmune hepatitis",
        "Fatty liver",
        "Cholelithiasis",
    ], DARK_BLUE, 10.4, 1.7),
    ("RENAL\n(Up to 10%)", [
        "Calcium oxalate stones (Crohn's)",
        "Uric acid stones",
        "Ureteral obstruction",
        "Amyloidosis (rare)",
    ], ORANGE, 0.3, 4.4),
    ("HAEMATOLOGICAL", [
        "Anaemia of chronic disease",
        "Iron deficiency anaemia",
        "B12/folate deficiency",
        "DVT / VTE (3× risk)",
        "Thrombocytosis",
    ], MID_BLUE, 3.8, 4.4),
    ("PULMONARY", [
        "Bronchiectasis",
        "Interstitial lung disease",
        "Pleuritis",
        "Airway inflammation",
    ], ACCENT_TEAL, 7.3, 4.4),
    ("NEUROLOGICAL", [
        "Peripheral neuropathy",
        "Cerebrovascular events (DVT/stroke)",
        "Mononeuritis multiplex",
    ], ACCENT_RED, 10.4, 4.4),
]
for (title, items, col, x, y) in systems:
    add_rect(s, x, y, 2.9, 0.5, fill=col)
    add_textbox(s, x+0.05, y+0.02, 2.8, 0.46, title, font_size=8.5, bold=True, color=WHITE)
    add_rect(s, x, y+0.5, 2.9, 2.3, fill=WHITE, line_color=col, line_width=1)
    add_multiline_textbox(s, x+0.08, y+0.52, 2.8, 2.2,
                          [{"text": f"• {i}", "size":9, "color":DARK_TEXT} for i in items],
                          font_size=9, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — DIAGNOSIS & INVESTIGATIONS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Diagnosis & Investigations", "No single gold standard — requires clinical, endoscopic, histological, and radiological correlation")
add_footer(s); add_slide_number(s, 9)

sections = [
    ("LABORATORY", [
        "FBC — anaemia (chronic/blood loss/B12/folate deficiency)",
        "WBC — mild elevation (active disease), marked ↑ = abscess",
        "ESR, CRP — non-specific inflammatory markers",
        "Fecal calprotectin — elevated in active disease, low in remission",
        "Albumin — hypoalbuminaemia in severe/active disease",
        "B12 — low with terminal ileal disease or resection >100 cm",
        "LFTs — to detect PSC (ALP, GGT elevation)",
    ], 0.3, 1.65, 6.1, MID_BLUE),
    ("SEROLOGICAL MARKERS", [
        "ASCA (Anti-Saccharomyces cerevisiae Ab) — positive 40–70% CD, <15% UC",
        "pANCA — positive 55% UC, 20% CD (colon-predominant)",
        "ASCA+/pANCA– → sensitivity 55%, specificity 93% for CD",
        "Anti-OmpC, anti-CBir1 — additional CD markers",
        "NOTE: Serology alone NOT diagnostic — supportive only",
    ], 6.7, 1.65, 6.3, ACCENT_TEAL),
    ("RADIOLOGY", [
        "CT enterography / MRI enterography — PREFERRED over barium studies",
        "Detects: strictures, fistulas, abscesses, bowel wall thickening",
        "MRI: No radiation — preferred for young patients and monitoring",
        "USS — useful for assessing bowel wall thickness",
        "Plain AXR — in acute severe IBD to exclude toxic megacolon",
        "CT scan: colonic dilation >6 cm = toxic megacolon",
    ], 0.3, 4.25, 6.1, ORANGE),
    ("ENDOSCOPY", [
        "Colonoscopy with biopsies — cornerstone of diagnosis",
        "Upper GI endoscopy — if upper GI CD suspected",
        "Capsule endoscopy — for small bowel CD (only if no strictures)",
        "MRI enterography / balloon enteroscopy for deep small bowel",
        "Repeat colonoscopy for surveillance of dysplasia in longstanding IBD",
    ], 6.7, 4.25, 6.3, DARK_BLUE),
]
for (title, items, x, y, w, col) in sections:
    add_rect(s, x, y, w, 0.42, fill=col)
    add_textbox(s, x+0.1, y+0.03, w-0.2, 0.38, title, font_size=11, bold=True, color=WHITE)
    add_rect(s, x, y+0.42, w, 2.35, fill=WHITE, line_color=col, line_width=1)
    add_multiline_textbox(s, x+0.1, y+0.46, w-0.2, 2.28,
                          [{"text": f"• {i}", "size":10, "color":DARK_TEXT} for i in items],
                          font_size=10, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — ENDOSCOPIC & HISTOLOGICAL FEATURES
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Endoscopic & Histological Features")
add_footer(s); add_slide_number(s, 10)

add_rect(s, 0.3, 1.65, 6.1, 5.5, fill=WHITE, line_color=MID_BLUE, line_width=1.5)
add_rect(s, 0.3, 1.65, 6.1, 0.45, fill=MID_BLUE)
add_textbox(s, 0.4, 1.68, 5.9, 0.42, "ULCERATIVE COLITIS", font_size=13, bold=True, color=WHITE)
add_multiline_textbox(s, 0.4, 2.15, 5.9, 4.9, [
    {"text":"Endoscopy:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Continuous inflammation from rectum proximally", "size":11},
    {"text":"• Diffuse mucosal erythema, loss of vascular pattern", "size":11},
    {"text":"• Granular, edematous mucosa (mild disease)", "size":11},
    {"text":"• Friable mucosa, contact bleeding (moderate)", "size":11},
    {"text":"• Ulceration, spontaneous bleeding (severe)", "size":11},
    {"text":"• Pseudopolyps — epithelial regeneration after recurrent attacks", "size":11},
    {"text":"• Chronic: colonic shortening, loss of haustration ('lead pipe')", "size":11},
    {"text":" "},
    {"text":"Histology:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Crypt distortion and architectural irregularity", "size":11},
    {"text":"• Cryptitis and crypt abscesses", "size":11},
    {"text":"• Acute inflammatory infiltrate in lamina propria", "size":11},
    {"text":"• Lymphocytic infiltrate in chronic disease", "size":11},
    {"text":"• Absent granulomas", "size":11},
    {"text":"• Mucin depletion from goblet cells", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

add_rect(s, 6.9, 1.65, 6.1, 5.5, fill=WHITE, line_color=ACCENT_TEAL, line_width=1.5)
add_rect(s, 6.9, 1.65, 6.1, 0.45, fill=ACCENT_TEAL)
add_textbox(s, 7.0, 1.68, 5.9, 0.42, "CROHN'S DISEASE", font_size=13, bold=True, color=WHITE)
add_multiline_textbox(s, 7.0, 2.15, 5.9, 4.9, [
    {"text":"Endoscopy:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Skip lesions — normal mucosa between diseased areas", "size":11},
    {"text":"• Deep, longitudinal/linear ulcers", "size":11},
    {"text":"• 'Cobblestone' mucosa — network of ulcers + oedematous islands", "size":11},
    {"text":"• Aphthous ulcers (earliest lesion)", "size":11},
    {"text":"• Strictures, stenosis", "size":11},
    {"text":"• Fistulous openings", "size":11},
    {"text":"• Any segment — terminal ileum most common", "size":11},
    {"text":" "},
    {"text":"Histology:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Transmural inflammation (all layers)", "size":11},
    {"text":"• Non-caseating granulomas (~50%) — PATHOGNOMONIC", "size":11},
    {"text":"• Lymphoid aggregates throughout bowel wall", "size":11},
    {"text":"• Fissuring ulcers penetrating deep into wall", "size":11},
    {"text":"• Preserved crypt architecture (early disease)", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — DISEASE ACTIVITY SCORING
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Disease Activity Scoring")
add_footer(s); add_slide_number(s, 11)

# UC scoring
add_rect(s, 0.3, 1.65, 6.1, 0.42, fill=MID_BLUE)
add_textbox(s, 0.4, 1.68, 5.9, 0.38, "ULCERATIVE COLITIS — Truelove & Witts Criteria", font_size=11, bold=True, color=WHITE)
add_rect(s, 0.3, 2.07, 6.1, 4.55, fill=WHITE, line_color=MID_BLUE, line_width=1)

uc_table = [
    ("CRITERION", "MILD", "MODERATE", "SEVERE"),
    ("Stools/day", "<4", "4–6", ">6"),
    ("Blood in stool", "Little", "Moderate", "Large"),
    ("Temp", "Normal", "<37.8°C", ">37.8°C"),
    ("Pulse", "Normal", "<90 bpm", ">90 bpm"),
    ("Haemoglobin", ">11 g/dL", "10.5–11", "<10.5 g/dL"),
    ("ESR", "<20 mm/hr", "20–30", ">30 mm/hr"),
]
col_colors = [LIGHT_GREY, RGBColor(0xD4, 0xED, 0xDA), ORANGE, ACCENT_RED]
for ri, row in enumerate(uc_table):
    for ci, cell in enumerate(row):
        cx = 0.3 + ci * 1.52
        cy = 2.07 + ri * 0.58
        bg = col_colors[ci] if ri == 0 else (LIGHT_GREY if ri % 2 == 0 else WHITE)
        if ri == 0: bg = col_colors[ci]
        add_rect(s, cx, cy, 1.52, 0.58, fill=bg)
        add_textbox(s, cx+0.05, cy+0.08, 1.42, 0.42, cell,
                    font_size=9.5, bold=(ri==0), color=WHITE if ri==0 else DARK_TEXT,
                    align=PP_ALIGN.CENTER)

# CD scoring
add_rect(s, 6.9, 1.65, 6.1, 0.42, fill=ACCENT_TEAL)
add_textbox(s, 7.0, 1.68, 5.9, 0.38, "CROHN'S DISEASE — Harvey-Bradshaw Index (HBI)", font_size=11, bold=True, color=WHITE)
add_rect(s, 6.9, 2.07, 6.1, 2.6, fill=WHITE, line_color=ACCENT_TEAL, line_width=1)
add_multiline_textbox(s, 7.0, 2.12, 5.9, 2.5, [
    {"text":"Score = Sum of 5 parameters:", "size":11, "bold":True, "color":DARK_BLUE},
    {"text":"1. General well-being (0–4)", "size":11},
    {"text":"2. Abdominal pain (0–3)", "size":11},
    {"text":"3. Abdominal mass (0–3)", "size":11},
    {"text":"4. Stool frequency (1 pt each)", "size":11},
    {"text":"5. Complications (1 pt each)", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=16)

add_rect(s, 6.9, 4.72, 6.1, 0.42, fill=DARK_BLUE)
add_textbox(s, 7.0, 4.75, 5.9, 0.38, "HBI Score Interpretation", font_size=11, bold=True, color=WHITE)
add_rect(s, 6.9, 5.14, 6.1, 1.5, fill=WHITE, line_color=DARK_BLUE, line_width=1)
add_multiline_textbox(s, 7.0, 5.18, 5.9, 1.4, [
    {"text":"• <5 → Remission", "size":11, "color":ACCENT_GREEN},
    {"text":"• 5–7 → Mild activity", "size":11, "color":ORANGE},
    {"text":"• 8–16 → Moderate activity", "size":11, "color":ORANGE},
    {"text":"• >16 → Severe activity", "size":11, "color":ACCENT_RED},
], font_size=11, color=DARK_TEXT, line_spacing=16)

add_textbox(s, 0.3, 6.7, 12.7, 0.35,
    "Other scoring: CDAI (Crohn's Disease Activity Index) — complex 8-variable score; Remission = CDAI <150; Moderate-severe = 220–450; Mayo Score for UC endoscopic severity",
    font_size=9, italic=True, color=DARK_BLUE)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 12 — MEDICAL MANAGEMENT
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Medical Management", "Step-up therapy: mild → moderate → severe disease")
add_footer(s); add_slide_number(s, 12)

steps = [
    ("STEP 1 — MILD DISEASE", [
        "Aminosalicylates (5-ASA): First-line for UC",
        "  Mesalazine (oral + topical), Sulfasalazine",
        "  Less effective in Crohn's disease",
        "Topical steroids: Rectal foam/suppositories for proctitis",
        "Antibiotics: Metronidazole / Ciprofloxacin for perianal CD",
        "Nutritional therapy: Exclusive enteral nutrition in paediatric CD",
    ], MID_BLUE, 0.3, 1.65, 6.0),
    ("STEP 2 — MODERATE DISEASE", [
        "Corticosteroids (systemic): Prednisolone 40–60 mg/day PO",
        "  Budesonide (ileal-release): preferred for ileocolonic CD",
        "  Hydrocortisone IV (200–300 mg/day) for hospitalised patients",
        "Immunomodulators:",
        "  Azathioprine (AZA) / 6-Mercaptopurine (6-MP)",
        "  Methotrexate (MTX) — CD maintenance",
        "  TPMT testing before thiopurines",
    ], ACCENT_TEAL, 0.3, 4.3, 6.0),
    ("STEP 3 — SEVERE / REFRACTORY DISEASE", [
        "Anti-TNF therapy: Infliximab, Adalimumab",
        "Anti-integrin: Vedolizumab (gut-selective)",
        "Anti-IL-12/23: Ustekinumab",
        "JAK inhibitors: Tofacitinib, Filgotinib (UC)",
        "Combination therapy: Biologic + immunomodulator > monotherapy",
        "Cyclosporin IV: Acute severe UC (rescue therapy)",
    ], DARK_BLUE, 6.6, 1.65, 6.4),
    ("MONITORING & SIDE EFFECTS", [
        "Steroids: Bone density, diabetes, cataracts, adrenal suppression",
        "Thiopurines: LFTs, FBC (3–6 monthly); pancreatitis, lymphoma risk",
        "Methotrexate: LFTs, FBC; teratogenic — contraception essential",
        "Anti-TNF: TB screening (IGRA), HBV screen, skin checks",
        "Vedolizumab: PML risk very low; generally gut-selective — safer",
        "JAK inhibitors: VTE risk, lipids, cardiovascular events (monitor)",
    ], ORANGE, 6.6, 4.3, 6.4),
]
for (title, items, col, x, y, w) in steps:
    add_rect(s, x, y, w, 0.42, fill=col)
    add_textbox(s, x+0.1, y+0.04, w-0.2, 0.36, title, font_size=11, bold=True, color=WHITE)
    add_rect(s, x, y+0.42, w, 2.4, fill=WHITE, line_color=col, line_width=1)
    add_multiline_textbox(s, x+0.1, y+0.46, w-0.2, 2.32,
                          [{"text": f"{'  ' if i.startswith('  ') else '• '}{i.strip()}", "size":10, "color":DARK_TEXT} for i in items],
                          font_size=10, color=DARK_TEXT, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 13 — BIOLOGIC & TARGETED THERAPIES
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Biologic & Targeted Therapies", "Mechanism-based treatments for moderate-to-severe IBD")
add_footer(s); add_slide_number(s, 13)

agents = [
    ("Anti-TNF\nAgents", ["Infliximab (IV)", "Adalimumab (SC)", "Certolizumab (SC, CD only)", "Golimumab (SC, UC only)"], "Neutralise TNF-α → block\npro-inflammatory cascade", "Both CD & UC\n(except Certolizumab = CD;\nGolimumab = UC only)", MID_BLUE),
    ("Anti-Integrin", ["Vedolizumab (IV/SC)"], "Blocks α4β7 integrin →\nprevents lymphocyte\nmigration to gut", "Both CD & UC\nGut-selective\n(safer profile)", ACCENT_TEAL),
    ("Anti-IL-12/23", ["Ustekinumab (IV then SC)", "Risankizumab (anti-IL-23)"], "Blocks p40 subunit of\nIL-12/IL-23 →\ninhibits Th1 & Th17", "CD & UC\nSafe in infections;\nno TB concern", DARK_BLUE),
    ("JAK Inhibitors\n(Small molecules)", ["Tofacitinib (UC)", "Filgotinib (UC)", "Upadacitinib (CD, UC)"], "Inhibit JAK1/3 →\nreduce cytokine\nsignalling", "Oral agents\nMonitor: VTE,\ncardiovascular, lipids", ORANGE),
]
add_rect(s, 0.3, 1.65, 2.5, 0.42, fill=DARK_TEXT)
for hdr, x in [("DRUG CLASS / AGENTS", 0.3),("KEY AGENTS", 2.8),("MECHANISM", 5.9),("INDICATION", 9.1),]:
    pass
headers = ["DRUG CLASS", "KEY AGENTS", "MECHANISM", "INDICATION / NOTES"]
col_widths = [2.5, 3.1, 3.2, 3.7]
col_starts = [0.3, 2.8, 5.9, 9.1]
for ci, (hdr, w, x) in enumerate(zip(headers, col_widths, col_starts)):
    add_rect(s, x, 1.65, w, 0.42, fill=DARK_TEXT)
    add_textbox(s, x+0.05, 1.67, w-0.1, 0.38, hdr, font_size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

for ri, (cls, agents_list, mech, ind, col) in enumerate(agents):
    y = 2.07 + ri * 1.18
    bg = RGBColor(0xF5, 0xF8, 0xFF) if ri % 2 == 0 else WHITE
    add_rect(s, col_starts[0], y, col_widths[0], 1.18, fill=col)
    add_textbox(s, col_starts[0]+0.05, y+0.1, col_widths[0]-0.1, 1.0, cls, font_size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(s, col_starts[1], y, col_widths[1], 1.18, fill=bg)
    add_multiline_textbox(s, col_starts[1]+0.08, y+0.1, col_widths[1]-0.1, 1.0,
                          [{"text": f"• {a}", "size":10, "color":DARK_TEXT} for a in agents_list], font_size=10)
    add_rect(s, col_starts[2], y, col_widths[2], 1.18, fill=bg)
    add_textbox(s, col_starts[2]+0.08, y+0.1, col_widths[2]-0.1, 1.0, mech, font_size=10, color=DARK_TEXT, wrap=True)
    add_rect(s, col_starts[3], y, col_widths[3], 1.18, fill=bg)
    add_textbox(s, col_starts[3]+0.08, y+0.1, col_widths[3]-0.1, 1.0, ind, font_size=10, color=DARK_TEXT, wrap=True)

add_textbox(s, 0.3, 6.75, 12.7, 0.35,
    "Key principle: Treat early and aggressively. Combination of biologic + immunomodulator > monotherapy (SONIC & UC SUCCESS trials). Monitor drug levels and antibody formation. Switch class (not agent) if adequate trough levels + active inflammation.",
    font_size=8.5, italic=True, color=DARK_BLUE)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 14 — SURGICAL MANAGEMENT
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Surgical Management")
add_footer(s); add_slide_number(s, 14)

add_rect(s, 0.3, 1.65, 6.0, 0.42, fill=MID_BLUE)
add_textbox(s, 0.4, 1.68, 5.8, 0.38, "CROHN'S DISEASE — Surgery is NOT curative", font_size=12, bold=True, color=WHITE)
add_rect(s, 0.3, 2.07, 6.0, 4.55, fill=WHITE, line_color=MID_BLUE, line_width=1)
add_multiline_textbox(s, 0.4, 2.12, 5.8, 4.45, [
    {"text":"Indications:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Obstruction not responding to steroids", "size":11},
    {"text":"• Intra-abdominal abscess (percutaneous drainage first, then resection)", "size":11},
    {"text":"• Fistulas refractory to medical therapy", "size":11},
    {"text":"• Failure of medical management", "size":11},
    {"text":"• Dysplasia or carcinoma", "size":11},
    {"text":" "},
    {"text":"Procedures:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Ileocolonic resection (most common for terminal ileal CD)", "size":11},
    {"text":"• Strictureplasty — bowel conservation for multiple strictures", "size":11},
    {"text":"• Ileostomy or colostomy (diverting procedures)", "size":11},
    {"text":"• Perianal drainage + seton placement", "size":11},
    {"text":" "},
    {"text":"Key point: Up to 70% of CD patients require surgery within 20 yrs.", "size":10, "italic":True, "color":ACCENT_RED},
    {"text":"Risk of recurrence after resection is high — post-op maintenance therapy essential.", "size":10, "italic":True, "color":ACCENT_RED},
], font_size=11, color=DARK_TEXT, line_spacing=15)

add_rect(s, 6.9, 1.65, 6.1, 0.42, fill=ACCENT_TEAL)
add_textbox(s, 7.0, 1.68, 5.9, 0.38, "ULCERATIVE COLITIS — Surgery IS curative", font_size=12, bold=True, color=WHITE)
add_rect(s, 6.9, 2.07, 6.1, 4.55, fill=WHITE, line_color=ACCENT_TEAL, line_width=1)
add_multiline_textbox(s, 7.0, 2.12, 5.9, 4.45, [
    {"text":"Indications:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Acute severe UC refractory to IV corticosteroids and rescue therapy", "size":11},
    {"text":"• Toxic megacolon (colonic dilation >6 cm)", "size":11},
    {"text":"• Intestinal perforation", "size":11},
    {"text":"• Dysplasia or colorectal carcinoma", "size":11},
    {"text":"• Chronic corticosteroid dependence / intolerance", "size":11},
    {"text":" "},
    {"text":"Gold Standard: Restorative Proctocolectomy", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Total proctocolectomy + ileal pouch-anal anastomosis (IPAA)", "size":11},
    {"text":"• 'J-pouch' construction — eliminates UC permanently", "size":11},
    {"text":"• Temporary loop ileostomy for pouch protection", "size":11},
    {"text":" "},
    {"text":"Alternative: Total proctocolectomy + permanent end ileostomy", "size":11},
    {"text":" "},
    {"text":"Complication: Pouchitis in ~50% of IPAA patients (usually antibiotic-responsive).", "size":10, "italic":True, "color":ACCENT_RED},
], font_size=11, color=DARK_TEXT, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 15 — COMPLICATIONS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Complications of IBD")
add_footer(s); add_slide_number(s, 15)

comps = [
    ("INTESTINAL", [
        ("Obstruction (CD)", "Most common reason for CD surgery; fibrous strictures respond to strictureplasty"),
        ("Abscesses (CD)", "15–20% of CD patients; fever + RLQ pain + leukocytosis; CT-guided drainage + antibiotics"),
        ("Fistulas (CD)", "Enteroenteric, enterovesical, enterovaginal; may require combined medical-surgical approach"),
        ("Toxic Megacolon", "Colonic dilation >6 cm; fever, tachycardia, leukocytosis; emergency — risk of perforation"),
        ("Perforation", "Surgical emergency; higher risk in severe UC and CD with transmural disease"),
        ("Haemorrhage", "Massive lower GI bleeding requiring colonoscopy, embolisation or surgery"),
    ], 0.3),
    ("SYSTEMIC", [
        ("VTE / DVT", "3× increased risk; thromboprophylaxis in hospitalised IBD patients; arterial events also increased"),
        ("Malnutrition", "From malabsorption, poor intake, increased catabolism; supplement B12, iron, folate, D, zinc"),
        ("Osteoporosis", "Steroid-related + disease-related; baseline DXA; Ca2+ + Vit D supplementation"),
        ("Growth retardation", "Important in paediatric CD; exclusive enteral nutrition preferred over steroids"),
        ("Anaemia", "Chronic disease, blood loss, haematinic deficiency; IV iron often required"),
        ("Drug side effects", "See medications slide; thiopurine lymphoma, anti-TNF infections, JAK inhibitor VTE"),
    ], 6.9),
]
for (title, items, x) in comps:
    add_rect(s, x, 1.65, 6.1, 0.42, fill=DARK_BLUE)
    add_textbox(s, x+0.1, 1.68, 5.9, 0.38, title + " COMPLICATIONS", font_size=12, bold=True, color=WHITE)
    for i, (comp, desc) in enumerate(items):
        y = 2.12 + i * 0.83
        add_rect(s, x, y, 6.1, 0.83, fill=RGBColor(0xF0, 0xF5, 0xFF) if i%2==0 else WHITE, line_color=LIGHT_GREY, line_width=0.5)
        add_textbox(s, x+0.1, y+0.06, 6.0, 0.28, comp, font_size=11, bold=True, color=DARK_BLUE)
        add_textbox(s, x+0.1, y+0.36, 6.0, 0.4, desc, font_size=9.5, color=DARK_TEXT, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 16 — IBD & COLORECTAL CANCER
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "IBD & Colorectal Cancer (CRC)", "Dysplasia surveillance is mandatory in long-standing IBD")
add_footer(s); add_slide_number(s, 16)

add_rect(s, 0.3, 1.65, 12.7, 0.42, fill=DARK_BLUE)
add_textbox(s, 0.4, 1.68, 12.5, 0.38, "RISK OF COLORECTAL CANCER", font_size=13, bold=True, color=WHITE)

add_rect(s, 0.3, 2.07, 4.0, 4.5, fill=WHITE, line_color=MID_BLUE, line_width=1)
add_multiline_textbox(s, 0.4, 2.12, 3.8, 4.4, [
    {"text":"UC Risk:", "size":12, "bold":True, "color":MID_BLUE},
    {"text":" "},
    {"text":"• Risk begins after 7 years of disease", "size":11},
    {"text":"• Rises ~10% per decade", "size":11},
    {"text":"• 15.8–34% at 30 years (referral centres)", "size":11},
    {"text":"• Greatest with pancolitis", "size":11},
    {"text":"• Left-sided colitis: onset ~1 decade later", "size":11},
    {"text":"• Proctitis alone: minimally increased risk", "size":11},
    {"text":" "},
    {"text":"Risk Correlates:", "size":12, "bold":True, "color":MID_BLUE},
    {"text":"• Duration + extent of disease", "size":11},
    {"text":"• Degree of chronic inflammation", "size":11},
    {"text":"• Family history of CRC", "size":11},
    {"text":"• Co-existing PSC (highest risk)", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

add_rect(s, 4.6, 2.07, 4.0, 4.5, fill=WHITE, line_color=ACCENT_TEAL, line_width=1)
add_multiline_textbox(s, 4.7, 2.12, 3.8, 4.4, [
    {"text":"Crohn's Disease Risk:", "size":12, "bold":True, "color":ACCENT_TEAL},
    {"text":" "},
    {"text":"• 4–20× general population risk", "size":11},
    {"text":"• Often arise from mucosa in bypassed/strictured segments", "size":11},
    {"text":"• Mucinous carcinomas common", "size":11},
    {"text":"• Can occur at younger age", "size":11},
    {"text":" "},
    {"text":"Dysplasia-Carcinoma Sequence:", "size":12, "bold":True, "color":ACCENT_TEAL},
    {"text":" "},
    {"text":"Normal mucosa → Low-grade dysplasia (LGD) → High-grade dysplasia (HGD) → Carcinoma", "size":11},
    {"text":" "},
    {"text":"• HGD: 25% have synchronous CRC at colectomy", "size":11},
    {"text":"• Back-to-back glands, nuclear pseudostratification, crypt distortion", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

add_rect(s, 8.9, 2.07, 4.1, 4.5, fill=WHITE, line_color=ORANGE, line_width=1)
add_multiline_textbox(s, 9.0, 2.12, 3.9, 4.4, [
    {"text":"Surveillance Guidelines:", "size":12, "bold":True, "color":ORANGE},
    {"text":" "},
    {"text":"• Begin colonoscopy surveillance 8–10 years after IBD onset", "size":11},
    {"text":"• Frequency: every 1–3 years (based on risk)", "size":11},
    {"text":"• HIGH RISK (PSC, extensive colitis): Annual", "size":11},
    {"text":"• MODERATE RISK: Every 2–3 years", "size":11},
    {"text":" "},
    {"text":"Chromoendoscopy:", "size":12, "bold":True, "color":ORANGE},
    {"text":"Preferred technique — dye spray enhances mucosal surface detail to detect dysplasia", "size":11},
    {"text":" "},
    {"text":"On finding HGD: Urgent colectomy recommended", "size":11, "bold":True, "color":ACCENT_RED},
    {"text":"On finding LGD: Multidisciplinary discussion; repeat colonoscopy or colectomy", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 17 — SPECIAL POPULATIONS & EMERGING THERAPIES
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Special Populations & Emerging Therapies")
add_footer(s); add_slide_number(s, 17)

add_rect(s, 0.3, 1.65, 6.0, 5.5, fill=WHITE, line_color=MID_BLUE, line_width=1)
add_rect(s, 0.3, 1.65, 6.0, 0.42, fill=MID_BLUE)
add_textbox(s, 0.4, 1.68, 5.8, 0.38, "SPECIAL POPULATIONS", font_size=12, bold=True, color=WHITE)
add_multiline_textbox(s, 0.4, 2.12, 5.8, 4.9, [
    {"text":"PREGNANCY:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Most IBD medications safe in pregnancy (except MTX — absolutely contraindicated)", "size":11},
    {"text":"• 5-ASA and biologics generally continued", "size":11},
    {"text":"• Active disease at conception = worse maternal/fetal outcomes", "size":11},
    {"text":"• Anti-TNF agents: Stop at ~week 24–32 to reduce cord transfer", "size":11},
    {"text":" "},
    {"text":"PAEDIATRIC IBD:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Exclusive enteral nutrition (EEN) = first-line induction (CD)", "size":11},
    {"text":"• Avoid long-term steroids — growth retardation", "size":11},
    {"text":"• Early biologic use favoured", "size":11},
    {"text":" "},
    {"text":"ELDERLY IBD:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Steroid side effects more severe — osteoporosis, delirium", "size":11},
    {"text":"• Drug interactions with polypharmacy — caution with thiopurines", "size":11},
    {"text":"• Higher VTE risk — prophylaxis in hospitalised patients", "size":11},
    {"text":" "},
    {"text":"IBD & COVID-19:", "size":11, "bold":True, "color":MID_BLUE},
    {"text":"• Immunosuppressants (steroids, thiopurines, JAK inhibitors) increase infection risk", "size":11},
    {"text":"• Biologics (vedolizumab) generally safer", "size":11},
    {"text":"• Vaccination strongly recommended (including COVID-19, flu, pneumococcal)", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=14)

add_rect(s, 6.9, 1.65, 6.1, 5.5, fill=WHITE, line_color=ACCENT_TEAL, line_width=1)
add_rect(s, 6.9, 1.65, 6.1, 0.42, fill=ACCENT_TEAL)
add_textbox(s, 7.0, 1.68, 5.9, 0.38, "EMERGING & FUTURE THERAPIES", font_size=12, bold=True, color=WHITE)
add_multiline_textbox(s, 7.0, 2.12, 5.9, 4.9, [
    {"text":"Selective JAK Inhibitors:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Upadacitinib (JAK1-selective) — approved CD & UC", "size":11},
    {"text":"• Filgotinib (JAK1-selective) — improved safety over tofacitinib", "size":11},
    {"text":" "},
    {"text":"Anti-IL-23 Antibodies:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Risankizumab, Mirikizumab, Guselkumab", "size":11},
    {"text":"• More specific than ustekinumab (targets p19 of IL-23 only)", "size":11},
    {"text":" "},
    {"text":"S1P Receptor Modulators:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Ozanimod (UC) — oral; retains lymphocytes in lymph nodes", "size":11},
    {"text":" "},
    {"text":"Microbiome-based Therapies:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Faecal microbiota transplantation (FMT) — active clinical trials in IBD", "size":11},
    {"text":"• Targeted microbial consortia — experimental", "size":11},
    {"text":" "},
    {"text":"Stem Cell Therapy:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Autologous HSCT in refractory CD — promising pilot data", "size":11},
    {"text":" "},
    {"text":"Precision / Personalised Medicine:", "size":11, "bold":True, "color":ACCENT_TEAL},
    {"text":"• Therapeutic drug monitoring (TDM) — optimise biologic dosing", "size":11},
    {"text":"• Biomarker-guided treatment selection", "size":11},
], font_size=11, color=DARK_TEXT, line_spacing=14)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 18 — MONITORING & FOLLOW-UP
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=LIGHT_BG)
add_header_bar(s, "Monitoring & Follow-up", "Treat to target: mucosal healing and clinical remission")
add_footer(s); add_slide_number(s, 18)

monitor_items = [
    ("Clinical", ["Regular symptom assessment (HBI/Mayo scores)", "Nutritional status, weight, BMI", "Growth velocity in children", "Quality of life assessment"]),
    ("Biochemical", ["FBC, ESR, CRP — every 3–6 months in active disease", "Fecal calprotectin — non-invasive mucosal healing marker", "Albumin, B12, folate, iron, zinc, vitamin D", "Drug levels + anti-drug antibodies (biologics)"]),
    ("Endoscopic", ["Colonoscopy: treat-to-target approach — mucosal healing endpoint", "Surveillance colonoscopy: 8–10 yrs after IBD onset", "Chromoendoscopy preferred for dysplasia detection", "MRI/CT enterography for Crohn's (transmural response)"]),
    ("Bone Health", ["DEXA scan at baseline — all patients on long-term steroids", "Ca2+ 1000–1200 mg/day + Vitamin D 800 IU/day", "Consider bisphosphonates if T-score < -2.5"]),
    ("Infection Screen", ["Annual flu vaccine; pneumococcal (every 5 yrs); Hepatitis B, HPV, VZV (pre-immunosuppression)", "TB IGRA screening before anti-TNF initiation", "Avoid live vaccines in immunosuppressed patients"]),
    ("Cancer Screen", ["Annual colonoscopy if PSC + pancolitis", "Cervical smear (increased CIN risk with immunosuppression)", "Skin checks (squamous cell carcinoma risk with thiopurines)", "Lymphoma awareness (thiopurines + anti-TNF)"]),
]
for i, (category, points) in enumerate(monitor_items):
    row = i // 3
    col = i % 3
    x = 0.3 + col * 4.35
    y = 1.65 + row * 2.7
    col_bg = [MID_BLUE, ACCENT_TEAL, DARK_BLUE, ORANGE, MID_BLUE, ACCENT_TEAL][i]
    add_rect(s, x, y, 4.05, 0.42, fill=col_bg)
    add_textbox(s, x+0.1, y+0.04, 3.85, 0.36, category.upper(), font_size=11, bold=True, color=WHITE)
    add_rect(s, x, y+0.42, 4.05, 2.2, fill=WHITE, line_color=col_bg, line_width=1)
    add_multiline_textbox(s, x+0.1, y+0.46, 3.85, 2.1,
                          [{"text": f"• {p}", "size":9.5, "color":DARK_TEXT} for p in points],
                          font_size=9.5, line_spacing=15)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 19 — KEY TAKEAWAYS
# ══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, fill=DARK_BLUE)
add_rect(s, 0, 1.5, 13.333, 0.07, fill=ACCENT_TEAL)
add_rect(s, 0, 5.9, 13.333, 1.6, fill=MID_BLUE)
add_textbox(s, 1.0, 0.3, 11.0, 0.6, "KEY TAKEAWAYS", font_size=13, bold=True, color=ACCENT_TEAL, align=PP_ALIGN.CENTER)
add_textbox(s, 1.0, 0.85, 11.0, 0.7, "Inflammatory Bowel Disease — Clinical Essentials",
            font_size=26, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_slide_number(s, 19)

takeaways = [
    ("1", "IBD = chronic relapsing GI inflammation; two main types: CD (transmural, any GI segment) and UC (mucosal, colon only).", MID_BLUE),
    ("2", "Pathophysiology: Genetic susceptibility (NOD2, IL23R) + dysbiosis + aberrant Th1/Th17 immune activation → uncontrolled inflammation.", ACCENT_TEAL),
    ("3", "Diagnosis requires endoscopy + histology; CT/MRI enterography for CD; serological markers are supportive but not diagnostic.", ORANGE),
    ("4", "Medical therapy is step-up: 5-ASA (UC) → steroids → immunomodulators → biologics (anti-TNF, vedolizumab, ustekinumab) → JAK inhibitors.", MID_BLUE),
    ("5", "Surgery cures UC (proctocolectomy); CD surgery (resection, strictureplasty) is not curative — 70% need surgery within 20 years.", ACCENT_TEAL),
    ("6", "Surveillance colonoscopy is mandatory from 8–10 years of disease; HGD = urgent colectomy.", ORANGE),
    ("7", "Treat-to-target: aim for mucosal healing + clinical remission; therapeutic drug monitoring optimises biologic outcomes.", MID_BLUE),
    ("8", "Extraintestinal manifestations (joints, skin, eyes, liver) affect up to 40% of patients — multidisciplinary management required.", ACCENT_TEAL),
]
for i, (num, text, col) in enumerate(takeaways):
    row = i // 2
    side = i % 2
    x = 0.4 + side * 6.5
    y = 1.7 + row * 0.98
    add_rect(s, x, y, 0.52, 0.52, fill=col)
    add_textbox(s, x, y, 0.52, 0.52, num, font_size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(s, x+0.52, y, 5.7, 0.52, fill=RGBColor(0x22, 0x4A, 0x80))
    add_textbox(s, x+0.6, y+0.06, 5.55, 0.42, text, font_size=10, color=WHITE, wrap=True)

add_textbox(s, 1.0, 6.0, 11.0, 0.45,
    "Sources: Sleisenger & Fordtran's Gastrointestinal and Liver Disease  |  Goldman-Cecil Medicine  |  Harrison's Principles of Internal Medicine 22E",
    font_size=9, italic=True, color=LIGHT_BG, align=PP_ALIGN.CENTER)
add_textbox(s, 1.0, 6.55, 11.0, 0.4,
    "Rosen's Emergency Medicine  |  Cellular & Molecular Immunology",
    font_size=9, italic=True, color=LIGHT_BG, align=PP_ALIGN.CENTER)

# ─────────────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/ibd-ppt/Inflammatory_Bowel_Disease.pptx"
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {out_path}")
print(f"Slides: {len(prs.slides)}")