ls -la /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace …

mkdir -p /home/daytona/workspace/surgical-cheatsheet && python3 -c "from reportl…

~/surgical-cheatsheet/generate_cheatsheet.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, PageBreak
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate

OUTPUT = "/home/daytona/workspace/surgical-cheatsheet/Surgical_Diseases_Cheatsheet.pdf"

# ─── Colour palette ──────────────────────────────────────────────────────────
DARK_BLUE   = colors.HexColor("#1A3557")
MED_BLUE    = colors.HexColor("#2E6DA4")
LIGHT_BLUE  = colors.HexColor("#D6E8F7")
ACCENT      = colors.HexColor("#E84545")
YELLOW_BG   = colors.HexColor("#FFF8DC")
GREEN_BG    = colors.HexColor("#EAF7EA")
ORANGE_BG   = colors.HexColor("#FFF3E0")
PURPLE_BG   = colors.HexColor("#F3E5F5")
GREY_BG     = colors.HexColor("#F5F5F5")
WHITE       = colors.white
TEXT_DARK   = colors.HexColor("#1C1C1C")

# ─── Styles ──────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def make_style(name, parent="Normal", **kwargs):
    s = ParagraphStyle(name, parent=styles[parent], **kwargs)
    return s

DOC_TITLE = make_style("DocTitle", fontSize=20, textColor=WHITE,
    fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=2)

SECTION_HEAD = make_style("SectionHead", fontSize=11, textColor=WHITE,
    fontName="Helvetica-Bold", alignment=TA_LEFT, spaceBefore=0, spaceAfter=0,
    leftIndent=4)

SUB_HEAD = make_style("SubHead", fontSize=9, textColor=DARK_BLUE,
    fontName="Helvetica-Bold", spaceBefore=4, spaceAfter=2)

BODY = make_style("Body", fontSize=7.5, textColor=TEXT_DARK,
    fontName="Helvetica", leading=11, spaceBefore=1, spaceAfter=1)

BODY_BOLD = make_style("BodyBold", fontSize=7.5, textColor=TEXT_DARK,
    fontName="Helvetica-Bold", leading=11)

BULLET = make_style("Bullet", fontSize=7.2, textColor=TEXT_DARK,
    fontName="Helvetica", leading=10.5, leftIndent=8, bulletIndent=0,
    spaceBefore=0.5, spaceAfter=0.5)

SMALL = make_style("Small", fontSize=6.8, textColor=colors.HexColor("#555555"),
    fontName="Helvetica", leading=9.5, spaceBefore=0, spaceAfter=0)

KEY = make_style("Key", fontSize=7.2, textColor=ACCENT,
    fontName="Helvetica-Bold", leading=10)

# ─── Helper builders ─────────────────────────────────────────────────────────
def section_banner(title, bg=DARK_BLUE):
    """Returns a coloured banner paragraph (used as a table cell)."""
    p = Paragraph(title, SECTION_HEAD)
    tbl = Table([[p]], colWidths=["100%"])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0, 0), (-1, -1), bg),
        ("TOPPADDING",    (0, 0), (-1, -1), 4),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 4),
        ("LEFTPADDING",   (0, 0), (-1, -1), 6),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 6),
        ("ROUNDEDCORNERS", [3, 3, 3, 3]),
    ]))
    return tbl

def two_col_table(left_items, right_items, bg=GREY_BG):
    """Two-column bullet table."""
    def fmt(items):
        return "\n".join(f"• {i}" for i in items)
    data = [[Paragraph(fmt(left_items), BULLET),
             Paragraph(fmt(right_items), BULLET)]]
    tbl = Table(data, colWidths=[9*cm, 9*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (-1, -1), bg),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 4),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 4),
        ("LEFTPADDING",   (0, 0), (-1, -1), 5),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
        ("LINEAFTER",     (0, 0), (0, -1),  0.5, colors.HexColor("#CCCCCC")),
    ]))
    return tbl

def info_box(label, content, bg=LIGHT_BLUE):
    data = [[Paragraph(f"<b>{label}</b>", BODY_BOLD),
             Paragraph(content, BODY)]]
    tbl = Table(data, colWidths=[3.5*cm, 14.5*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (-1, -1), bg),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 3),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 3),
        ("LEFTPADDING",   (0, 0), (-1, -1), 5),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
        ("LINEAFTER",     (0, 0), (0, -1), 1, MED_BLUE),
    ]))
    return tbl

def score_table(headers, rows, col_widths=None):
    data = [[Paragraph(h, BODY_BOLD) for h in headers]] + \
           [[Paragraph(str(c), BODY) for c in row] for row in rows]
    if not col_widths:
        col_widths = [18*cm / len(headers)] * len(headers)
    tbl = Table(data, colWidths=col_widths)
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (-1, 0),  DARK_BLUE),
        ("TEXTCOLOR",     (0, 0), (-1, 0),  WHITE),
        ("FONTNAME",      (0, 0), (-1, 0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0, 0), (-1, -1), 7),
        ("ROWBACKGROUNDS",(0, 1), (-1, -1), [WHITE, GREY_BG]),
        ("GRID",          (0, 0), (-1, -1), 0.3, colors.HexColor("#CCCCCC")),
        ("TOPPADDING",    (0, 0), (-1, -1), 3),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 3),
        ("LEFTPADDING",   (0, 0), (-1, -1), 4),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 4),
        ("VALIGN",        (0, 0), (-1, -1), "MIDDLE"),
    ]))
    return tbl

def bullets(items, bg=None):
    lines = [Paragraph(f"• {i}", BULLET) for i in items]
    if bg:
        tbl = Table([[l] for l in lines], colWidths=["100%"])
        tbl.setStyle(TableStyle([
            ("BACKGROUND", (0, 0), (-1, -1), bg),
            ("TOPPADDING", (0, 0), (-1, -1), 1),
            ("BOTTOMPADDING", (0, 0), (-1, -1), 1),
            ("LEFTPADDING", (0, 0), (-1, -1), 5),
            ("RIGHTPADDING", (0, 0), (-1, -1), 5),
        ]))
        return tbl
    return lines

def sp(h=3):
    return Spacer(1, h)

def hr():
    return HRFlowable(width="100%", thickness=0.5,
                      color=colors.HexColor("#CCCCCC"), spaceAfter=3, spaceBefore=3)

# ─── Document setup ──────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.5*cm, leftMargin=1.5*cm,
    topMargin=1.8*cm, bottomMargin=1.5*cm,
    title="Surgical Diseases — Exam Cheat Sheet",
    author="UTMA 4-Year Exam Prep"
)

story = []

# ═══════════════════════════════════════════════════════════════════════════════
# COVER BANNER
# ═══════════════════════════════════════════════════════════════════════════════
cover = Table(
    [[Paragraph("SURGICAL DISEASES", DOC_TITLE)],
     [Paragraph("UTMA 4-Year Exam — Quick Reference Cheat Sheet", make_style(
         "Sub", fontSize=10, textColor=LIGHT_BLUE,
         fontName="Helvetica", alignment=TA_CENTER))]],
    colWidths=["100%"]
)
cover.setStyle(TableStyle([
    ("BACKGROUND",    (0, 0), (-1, -1), DARK_BLUE),
    ("TOPPADDING",    (0, 0), (-1, -1), 8),
    ("BOTTOMPADDING", (0, 0), (-1, -1), 8),
    ("LEFTPADDING",   (0, 0), (-1, -1), 10),
    ("ROUNDEDCORNERS", [4, 4, 4, 4]),
]))
story += [cover, sp(8)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 1 — ACUTE APPENDICITIS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("1. ACUTE APPENDICITIS", DARK_BLUE), sp(4)]

story += [Paragraph("Q1 — Causes & Etiologic Factors", SUB_HEAD)]
story += [info_box("Key cause", "Luminal obstruction → bacterial proliferation → inflammation → gangrene → perforation", LIGHT_BLUE), sp(2)]
story += [two_col_table(
    ["Faecolith (appendicolith) — MOST COMMON",
     "Lymphoid hyperplasia (viral infections in children)",
     "Stricture / foreign body / worms",
     "Carcinoid tumour of appendix"],
    ["Low dietary fibre / high refined carbohydrates",
     "Mixed aerobic + anaerobic bacteria",
     "Peak incidence: teens & early twenties",
     "M:F = 3:2 at age 25"],
    GREY_BG
), sp(4)]

story += [Paragraph("Q2 — Clinical Signs & Symptoms", SUB_HEAD)]
story += [two_col_table(
    ["Periumbilical colicky pain (visceral — FIRST)",
     "Pain SHIFTS to RIF (somatic — parietal peritoneum)",
     "Anorexia — constant reliable feature",
     "Nausea + 1–2 episodes vomiting (follow pain)",
     "Low-grade fever 37.2–37.7°C (after 6 hrs)",
     "Constipation / occasional diarrhoea (pelvic)"],
    ["Tenderness at McBurney's point",
     "Guarding & rigidity in RIF",
     "Rovsing's sign — LIF pressure → RIF pain",
     "Rebound tenderness (Blumberg's sign)",
     "Psoas sign — retrocaecal appendix",
     "Obturator sign — pelvic appendix"],
    GREEN_BG
), sp(2)]
story += [info_box("Classic sequence", "Periumbilical colic → Anorexia → Nausea/vomiting → RIF pain → Fever → Leucocytosis (Murphy's sequence)", YELLOW_BG), sp(4)]

story += [Paragraph("Q3 — Complications", SUB_HEAD)]
story += [two_col_table(
    ["Perforation (most important — extremes of age)",
     "Appendix mass / phlegmon",
     "Appendix abscess",
     "Generalised peritonitis"],
    ["Pelvic abscess (dull ache PR, diarrhoea)",
     "Subphrenic abscess (shoulder pain, hiccup)",
     "Portal pyaemia / pylephlebitis (jaundice, high fever)",
     "Adhesive bowel obstruction (late)"],
    ORANGE_BG
), sp(4)]

story += [Paragraph("Q4 — Diagnosis & Treatment", SUB_HEAD)]
story += [Paragraph("Alvarado Score (MANTRELS) — Score ≥7 = operate; 5–6 = imaging", BODY_BOLD), sp(2)]
story += [score_table(
    ["Feature", "Score"],
    [["Migration of pain to RIF", "1"],
     ["Anorexia", "1"],
     ["Nausea / Vomiting", "1"],
     ["Tenderness in RIF", "2"],
     ["Rebound tenderness", "1"],
     ["Elevated temperature >37.3°C", "1"],
     ["Leucocytosis", "2"],
     ["Shift to left (neutrophilia)", "1"],
     ["TOTAL", "10"]],
    [7*cm, 11*cm]
), sp(3)]
story += [two_col_table(
    ["USS — 1st line (children, thin, gynaecological Δ)",
     "CT abdomen/pelvis — gold std, sensitivity 95%",
     "MRI — pregnancy",
     "FBC (leucocytosis + neutrophilia), CRP, β-hCG"],
    ["Lichtenstein open mesh appendicectomy (standard)",
     "Laparoscopic appendicectomy (preferred in women, obese)",
     "IV antibiotics pre-op: cefuroxime + metronidazole",
     "Phlegmon: Ochsner-Sherren regimen → interval appendicectomy 6–8 wks"],
    GREY_BG
), sp(4)]

story += [Paragraph("Q5 — Post-Appendicectomy Complications", SUB_HEAD)]
story += [two_col_table(
    ["Wound infection (MOST COMMON early)",
     "Intra-abdominal / pelvic abscess",
     "Paralytic ileus",
     "Faecal fistula (rare — closes spontaneously)",
     "Haemorrhage (mesoappendix)"],
    ["Adhesive small bowel obstruction (MOST COMMON late)",
     "Incisional hernia",
     "Infertility in women (tubal adhesions)",
     "DVT / PE",
     "Stump appendicitis (if >1 cm stump left)"],
    GREY_BG
), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 2 — INGUINAL HERNIA
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("2. INGUINAL HERNIA", MED_BLUE), sp(4)]

story += [Paragraph("Q6 — Causes, Risk Factors & Diagnosis", SUB_HEAD)]
story += [info_box("Types", "INDIRECT: through deep inguinal ring, lateral to inferior epigastric vessels; can reach scrotum; congenital/acquired\nDIRECT: through Hesselbach's triangle (posterior wall), medial to epigastrics; always acquired; broad neck", LIGHT_BLUE), sp(2)]
story += [two_col_table(
    ["Patent processus vaginalis (indirect — congenital)",
     "Posterior wall weakness (direct — acquired)",
     "Male sex (10× more common than female)"],
    ["Raised IAP: cough, constipation, BPH, ascites, obesity",
     "Smoking (impairs collagen cross-linking)",
     "Collagen disorders; family history; previous repair"],
    GREY_BG
), sp(2)]
story += [info_box("Diagnosis", "Lump ABOVE & MEDIAL to pubic tubercle. Cough impulse. Indirect: controlled by pressure at deep ring. Direct: broad-based, disappears with flat-hand pressure over Hesselbach's. USS / CT for occult hernias.", YELLOW_BG), sp(4)]

story += [Paragraph("Q7 — Clinical Features & Complications", SUB_HEAD)]
story += [two_col_table(
    ["Groin swelling — appears on standing/coughing",
     "Reducible on lying",
     "Dragging/aching discomfort",
     "Indirect: narrow neck, scrotum, cough impulse at deep ring",
     "Direct: broad-based, rarely reaches scrotum"],
    ["Irreducibility → Obstruction → STRANGULATION",
     "Strangulation: tense tender irreducible, no cough impulse, systemic toxicity",
     "Maydl's hernia (W-hernia): strangulation of middle loop inside abdomen",
     "Sliding hernia: viscus (caecum/sigmoid) forms part of sac wall",
     "Narrow-necked indirect hernias → highest strangulation risk"],
    ORANGE_BG
), sp(4)]

story += [Paragraph("Q8 — Treatment", SUB_HEAD)]
story += [score_table(
    ["Operation", "Approach", "Key Points"],
    [["Lichtenstein", "Open mesh (tension-free)", "Most common worldwide; mesh behind cord; lowest recurrence; chronic pain up to 20%"],
     ["Shouldice", "Open tissue (4-layer)", "Best tissue repair; recurrence ~1% in specialist centres"],
     ["Bassini", "Open tissue", "Historical; higher recurrence"],
     ["TEP", "Laparoscopic", "Extraperitoneal; large mesh; bilateral/recurrent; preferred laparoscopic"],
     ["TAPP", "Laparoscopic", "Enters peritoneum; useful for recurrent/bilateral"],
     ["Herniotomy", "Open (paediatric)", "Ligation of sac at deep ring only; no mesh"]],
    [3.5*cm, 3.5*cm, 11*cm]
), sp(4)]

story += [Paragraph("Q9 — Postoperative Complications", SUB_HEAD)]
story += [two_col_table(
    ["Urinary retention (early, esp. elderly males)",
     "Haematoma / scrotal oedema",
     "Wound infection",
     "Ischaemic orchitis → testicular atrophy",
     "Vas deferens injury (infertility if bilateral)"],
    ["Chronic groin pain / inguinodynia (MOST COMMON late) — nerve entrapment / mesh",
     "Hernia recurrence (1–5% mesh; higher tissue repair)",
     "Seroma (resolves spontaneously)",
     "Mesh migration / erosion (rare)",
     "Hydrocele (lymphatic damage)"],
    GREY_BG
), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 3 — FEMORAL HERNIA
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("3. FEMORAL HERNIA", colors.HexColor("#2C7BB6")), sp(4)]

story += [Paragraph("Q10 — Causes & Risk Factors", SUB_HEAD)]
story += [info_box("Boundaries of femoral canal",
    "Lateral: femoral vein | Anterior: inguinal ligament | Posterior: Cooper's (iliopectineal) ligament | Medial: lacunar (Gimbernat's) ligament — SHARP, UNYIELDING → causes strangulation",
    LIGHT_BLUE), sp(2)]
story += [two_col_table(
    ["Female sex M:F = 1:4 (wider pelvis → wider canal)",
     "Thin elderly women (loss of fat support)",
     "Multiparity (stretches abdominal wall)"],
    ["Raised IAP: chronic cough, constipation, ascites",
     "Weight loss (reduces fat in canal)",
     "Previous inguinal hernia repair"],
    GREY_BG
), sp(4)]

story += [Paragraph("Q11 — Clinical Features & Complications", SUB_HEAD)]
story += [info_box("Key landmark", "Appears BELOW & LATERAL to pubic tubercle (inguinal hernia is above and medial)", YELLOW_BG), sp(2)]
story += [two_col_table(
    ["Small lump (1–2 cm), often missed / mistaken for lymph node",
     "Rapidly becomes irreducible (tight ring)",
     "May point SUPERIORLY → mimics inguinal hernia",
     "Thin, elderly women; often no prior warning"],
    ["Strangulation in ~50% at presentation (EMERGENCY)",
     "Lacunar ligament → unyielding neck",
     "Richter's hernia (partial bowel wall strangulation)",
     "Richter's: bowel necrosis WITHOUT full obstruction picture"],
    ORANGE_BG
), sp(4)]

story += [Paragraph("Q12 — Diagnosis & Treatment", SUB_HEAD)]
story += [score_table(
    ["Approach", "Access", "Best For"],
    [["Lockwood (low)", "Below inguinal ligament", "Emergency; simple cases; direct access"],
     ["McEvedy (high)", "Vertical above inguinal ligament", "STRANGULATION — best bowel access for resection"],
     ["Lothiessen (inguinal)", "Through inguinal canal", "Rarely used; weakens inguinal floor"],
     ["Laparoscopic TEP/TAPP", "Preperitoneal", "Elective; bilateral repair; large mesh covers femoral + inguinal"]],
    [3.5*cm, 5*cm, 9.5*cm]
), sp(2)]
story += [info_box("WARNING", "Dividing lacunar ligament risks corona mortis (aberrant obturator artery) — control haemorrhage before dividing", ORANGE_BG), sp(4)]

story += [Paragraph("Q13 — Postoperative Complications", SUB_HEAD)]
story += [two_col_table(
    ["Wound infection / lymphocele / lymph fistula",
     "Femoral vein or artery injury",
     "Femoral nerve injury (anterior thigh numbness)",
     "Obturator artery injury (corona mortis)"],
    ["Recurrence (~1–5%)",
     "DVT (elderly patients)",
     "Bowel complications if resection: anastomotic leak",
     "Urinary retention"],
    GREY_BG
), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 4 — UMBILICAL HERNIA
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("4. UMBILICAL HERNIA", colors.HexColor("#1B6CA8")), sp(4)]

story += [Paragraph("Q14 — Causes, Risk Factors & Diagnosis", SUB_HEAD)]
story += [score_table(
    ["Type", "Age", "Cause", "Management"],
    [["Congenital / Infantile", "Neonates", "Failure of umbilical ring to contract", "Most resolve by 2–3 yrs; surgery if persists >4–5 yrs"],
     ["Para-umbilical (adult)", "Adults", "Weakness of linea alba; raised IAP", "Always repair (high strangulation risk)"],
     ["Exomphalos", "Neonate", "Failure of gut to return to abdomen; contents in umbilical cord", "Surgical emergency"]],
    [3*cm, 2.5*cm, 6*cm, 6.5*cm]
), sp(2)]
story += [info_box("Adult risk factors",
    "Obesity (MOST IMPORTANT) | Multiparity | Ascites/cirrhosis | Chronic cough | Steroids | Malnutrition",
    LIGHT_BLUE), sp(4)]

story += [Paragraph("Q15 — Clinical Features & Complications", SUB_HEAD)]
story += [two_col_table(
    ["Paediatric: soft reducible umbilical swelling on crying",
     "Adult: lump at/near umbilicus, often irreducible",
     "Omentum (most common content in adults)",
     "Thinned/excoriated overlying skin in large hernias",
     "Dragging discomfort"],
    ["Irreducibility (very common in adults)",
     "Obstruction / Strangulation",
     "Rupture (cirrhotic with tense ascites — EMERGENCY)",
     "Skin breakdown / ulceration",
     "Hepatic decompensation (post-op in cirrhosis)"],
    ORANGE_BG
), sp(4)]

story += [Paragraph("Q16 — Treatment", SUB_HEAD)]
story += [score_table(
    ["Technique", "Details", "Recurrence"],
    [["Herniotomy (paediatric)", "Periumbilical incision; sac excised; ring sutured", "Low"],
     ["Mayo's repair (vest-over-pants)", "Double-breasting upper flap over lower flap; no mesh", "10–20%"],
     ["Sublay mesh (Rives-Stoppa)", "Mesh behind rectus; GOLD STANDARD adults", "<5%"],
     ["Laparoscopic IPOM", "Intraperitoneal composite mesh; for obese/large defects", "<5%"]],
    [4*cm, 10*cm, 4*cm]
), sp(4)]

story += [Paragraph("Q17 — Postoperative Complications", SUB_HEAD)]
story += [two_col_table(
    ["Seroma (MOST COMMON — usually resolves)",
     "Wound infection",
     "Haematoma",
     "Skin necrosis (if elliptical excision too large)"],
    ["Recurrence: 10–20% tissue; <5% mesh",
     "Mesh complications: infection, migration, bowel fistula",
     "Chronic pain (nerve entrapment)",
     "Cirrhotic: ascitic leak, hepatic decompensation"],
    GREY_BG
), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 5 — EPIGASTRIC HERNIA
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("5. EPIGASTRIC HERNIA", colors.HexColor("#5B4A8A")), sp(4)]

story += [Paragraph("Q18 — Causes, Symptoms, Diagnosis & Treatment", SUB_HEAD)]
story += [info_box("Definition", "Pre-peritoneal fat protrusion through defect in linea alba between xiphoid and umbilicus. Usually small (1–2 cm). Multiple defects common.", PURPLE_BG), sp(2)]
story += [two_col_table(
    ["Defect in decussating fibres of linea alba",
     "Raised IAP (obesity, straining)",
     "Nerve/vessel perforation sites → inherent weakness",
     "Small tender midline epigastric nodule",
     "Often NOT reducible (pre-peritoneal fat trapped)",
     "Burning epigastric pain → MIMICS peptic ulcer / biliary colic"],
    ["Diagnosis: USS (identifies fat content, defect); CT confirms",
     "EXCLUDE peptic ulcer & gallstones first (endoscopy, USS)",
     "Treatment: Elective repair for symptomatic hernias",
     "Small defects: direct suture with non-absorbable sutures",
     "Larger defects (>1 cm): onlay or sublay mesh",
     "Laparoscopic: obese / multiple defects"],
    PURPLE_BG
), sp(4)]

story += [Paragraph("Q19 — Postoperative Complications", SUB_HEAD)]
story += [two_col_table(
    ["Recurrence (if direct suture used for >1 cm defect)",
     "Wound infection",
     "Haematoma / Seroma"],
    ["Chronic epigastric pain (nerve entrapment)",
     "Mesh complications (rare: seroma, infection)",
     "Persistent epigastric symptoms if peptic ulcer/biliary disease not excluded pre-op"],
    GREY_BG
), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 6 — INCISIONAL HERNIA
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("6. INCISIONAL HERNIA", colors.HexColor("#2E7D32")), sp(4)]

story += [Paragraph("Q20 — Causes & Risk Factors", SUB_HEAD)]
story += [two_col_table(
    ["Wound infection (MOST IMPORTANT PREVENTABLE)",
     "Haematoma / seroma (impairs healing)",
     "Suture failure / wrong suture material",
     "Excessive tension on closure",
     "Midline incisions (higher risk than transverse)",
     "Poor closure technique"],
    ["Obesity (MOST SIGNIFICANT modifiable patient factor)",
     "Diabetes mellitus",
     "Malnutrition / hypoalbuminaemia",
     "Smoking",
     "Immunosuppression / corticosteroids",
     "Post-op chest infection / paralytic ileus (raises IAP)"],
    GREEN_BG
), sp(4)]

story += [Paragraph("Q21 — Symptoms & Diagnosis", SUB_HEAD)]
story += [two_col_table(
    ["Swelling / bulge at scar — on standing/straining",
     "Reduces on lying (if reducible)",
     "Dragging discomfort at hernia site",
     "Increasing size over time",
     "Thinned / excoriated skin over large hernias"],
    ["CT scan (GOLD STANDARD): defect size/number, contents, muscle quality, loss of domain",
     "USS: small/simple hernias",
     "Cough impulse through fascial defect on examination",
     "Assess reducibility and size of fascial ring"],
    GREY_BG
), sp(4)]

story += [Paragraph("Q22 — Treatment", SUB_HEAD)]
story += [score_table(
    ["Technique", "Mesh Position", "Best For"],
    [["Primary suture (no mesh)", "None", "Small defects <2 cm only; high recurrence 30–50% for larger"],
     ["Onlay mesh", "Anterior to closed fascia", "Simple; higher infection (superficial mesh)"],
     ["Sublay / Rives-Stoppa", "Retromuscular / preperitoneal", "GOLD STANDARD; lowest recurrence; large defects"],
     ["Components separation (CST)", "Sublay + CST", "Massive hernias with loss of domain; bilateral external oblique release"],
     ["Laparoscopic IPOM", "Intraperitoneal", "Moderate defects; obese; reduced wound complications"]],
    [4*cm, 4.5*cm, 9.5*cm]
), sp(2)]
story += [info_box("Emergency (obstructed/strangulated)", "Laparotomy; assess bowel viability; resect if needed; AVOID synthetic mesh in contaminated field — use biologic mesh or temporary closure", ORANGE_BG), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 7 — AMOEBIC LIVER ABSCESS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("7. AMOEBIC LIVER ABSCESS", colors.HexColor("#B71C1C")), sp(4)]

story += [Paragraph("Q23 — Pathology & Clinical Features", SUB_HEAD)]
story += [info_box("Organism", "Entamoeba histolytica (trophozoite) | Faeco-oral route → intestinal infection → portal circulation → liver", LIGHT_BLUE), sp(2)]
story += [info_box("Pathology",
    "Right lobe 75–80% | Chocolate-brown / anchovy-paste contents (NOT pus — liquefied liver cells + RBCs) | Solitary unilocular | No bacteria | Trophozoites at wall",
    YELLOW_BG), sp(2)]
story += [two_col_table(
    ["Young male in endemic area",
     "High intermittent fever with rigors",
     "RUQ pain → right shoulder (diaphragmatic referral)",
     "Tender hepatomegaly (right lobe)"],
    ["Weight loss, anorexia",
     "Dysentery in ~50% (not always)",
     "Intercostal tenderness (right lower chest)",
     "Elevated right hemidiaphragm on CXR; right pleural effusion"],
    GREY_BG
), sp(4)]

story += [Paragraph("Q24 — Complications & Diagnosis", SUB_HEAD)]
story += [two_col_table(
    ["Rupture into pleural cavity (MOST COMMON) → empyema; hepatobronchial fistula",
     "Coughing chocolate material = PATHOGNOMONIC of hepatobronchial fistula",
     "Rupture into pericardium (left lobe abscess) → MOST DANGEROUS → tamponade",
     "Rupture into peritoneum → peritonitis"],
    ["Secondary bacterial infection",
     "Rupture into stomach/colon (fistula)",
     "Lung abscess (direct diaphragmatic extension)",
     "IVC thrombosis (very rare)"],
    ORANGE_BG
), sp(2)]
story += [score_table(
    ["Investigation", "Finding"],
    [["Amoebic serology (ELISA/IHA)", "POSITIVE >90% — MOST USEFUL confirmatory test"],
     ["USS (first-line imaging)", "Well-defined hypoechoic round/oval lesion, right lobe; guides aspiration"],
     ["CT scan", "Low attenuation mass with peripheral rim enhancement ('rim sign')"],
     ["FBC", "Leucocytosis, anaemia (chronic)"],
     ["LFTs", "Elevated ALP (most consistent); ↑ bilirubin if biliary compression"],
     ["Aspirate appearance", "Chocolate/anchovy-paste; culture negative; trophozoites rarely in fluid"],
     ["Stool exam", "Cysts/trophozoites in <50% — unreliable"]],
    [6*cm, 12*cm]
), sp(4)]

story += [Paragraph("Q25 — Treatment", SUB_HEAD)]
story += [info_box("Drug of choice", "Metronidazole 800 mg TDS × 10 days → >90% respond. FOLLOW with luminal amoebicide: Diloxanide furoate 500 mg TDS × 10 days (eradicate intestinal carriage)", GREEN_BG), sp(2)]
story += [score_table(
    ["Indication for Aspiration", "Technique"],
    [["Abscess >5–10 cm (rupture risk)", "USS-guided percutaneous needle aspiration"],
     ["No response to metronidazole after 72 hours", "Percutaneous catheter drain if aspiration insufficient"],
     ["Left lobe abscess (cardiac rupture risk)", ""],
     ["Threatening/actual rupture into pleura/peritoneum", ""],
     ["Exclude pyogenic abscess (diagnostic aspiration)", ""]],
    [10*cm, 8*cm]
), sp(2)]
story += [info_box("Surgical drainage", "RARELY required. Indications: secondary infection not responding; rupture into peritoneum/pericardium; failure of aspiration + antibiotics", ORANGE_BG), sp(6)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 8 — PYOGENIC LIVER ABSCESS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_banner("8. PYOGENIC LIVER ABSCESS — AETIOLOGY", colors.HexColor("#E65100")), sp(4)]

story += [Paragraph("Q26 — Aetiology", SUB_HEAD)]
story += [info_box("Organisms",
    "Klebsiella pneumoniae (increasingly most common, esp. Asia) | E. coli | Streptococcus milleri | Bacteroides | Staphylococcus aureus (immunocompromised) | POLYMICROBIAL in majority",
    LIGHT_BLUE), sp(2)]
story += [score_table(
    ["Route", "Source / Disease", "%"],
    [["Biliary (ascending cholangitis)", "Bile duct stones, biliary strictures, malignancy, stents, ERCP", "35% (MOST COMMON)"],
     ["Portal vein (pylephlebitis)", "Appendicitis, diverticulitis, Crohn's, IBD, colorectal malignancy", "20%"],
     ["Hepatic artery (bacteraemia)", "Septicaemia, bacterial endocarditis, IV drug use", "15%"],
     ["Direct spread", "Subphrenic abscess, empyema gallbladder, perforated DU, trauma", "Uncommon"],
     ["Post-procedure", "After liver biopsy, ERCP, TACE for HCC, liver surgery", "Uncommon"],
     ["Cryptogenic", "No identifiable source", "10–15%"]],
    [4.5*cm, 9*cm, 4.5*cm]
), sp(2)]
story += [info_box("Risk factors",
    "Age >50 | Diabetes mellitus (most important for severe/recurrent) | Immunosuppression | Biliary disease | IBD | Recent abdominal surgery",
    YELLOW_BG), sp(2)]
story += [info_box("Key distinction from amoebic abscess",
    "Pyogenic: true bacterial pus (creamy yellow), polymicrobial, usually multiple lesions, any age/sex, no serology, often known biliary/GI source\n"
    "Amoebic: chocolate/anchovy paste (NOT pus), young male, serology +ve, single right lobe lesion, history of dysentery",
    ORANGE_BG), sp(6)]

# ─── Footer note ──────────────────────────────────────────────────────────────
story += [hr()]
story += [Paragraph("Reference: SRB's Manual of Surgery, 6th Edition | Bailey & Love's Short Practice of Surgery, 28th Edition", SMALL)]
story += [Paragraph("UTMA 4-Year Exam — Surgical Diseases Cheat Sheet | Generated for Exam Preparation", SMALL)]

# ─── Build ────────────────────────────────────────────────────────────────────
def add_page_number(canvas, doc):
    canvas.saveState()
    canvas.setFont("Helvetica", 7)
    canvas.setFillColor(colors.HexColor("#888888"))
    canvas.drawRightString(A4[0] - 1.5*cm, 1*cm, f"Page {doc.page}")
    canvas.restoreState()

doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number)
print(f"PDF generated: {OUTPUT}")