cd /tmp/workspace && python3 -c " import pdfplumber pdf_path = '/tmp/workspace/attachments/608e9b59-171c-4f6a-ad2b-c1ad1c638dd7/Archith Boloor insiders guide to clinical medicine 2020_compressed.pdf' with pdfplumber.open(pdf_path) as pdf: print(f'Total pages: {len(pdf.pages)}') # Search for GI system content for i, page in enumerate(pdf.pages): text = page.extract_text() if text and ('gastrointestinal' in text.lower() or 'abdominal' in text.lower() or 'gi system' in text.lower() or 'abdomen' in text.lower()): print(f'Page {i+1}: GI content found') " 2>&1 | head -60

cd /tmp/workspace && python3 -c " import pdfplumber pdf_path = '/tmp/workspace/attachments/608e9b59-171c-4f6a-ad2b-c1ad1c638dd7/Archith Boloor insiders guide to clinical medicine 2020_compressed.pdf' with pdfplumber.open(pdf_path) as pdf: # Look for the GI examination chapter specifically for i in range(230, 290): text = pdf.pages[i].extract_text() if text: print(f'=== PAGE {i+1} ===') print(text[:800]) print() " 2>&1 | head -300

cd /tmp/workspace && python3 -c " import pdfplumber pdf_path = '/tmp/workspace/attachments/608e9b59-171c-4f6a-ad2b-c1ad1c638dd7/Archith Boloor insiders guide to clinical medicine 2020_compressed.pdf' with pdfplumber.open(pdf_path) as pdf: # Extract pages 241-350 (GI chapter) for i in range(240, 360): text = pdf.pages[i].extract_text() if text: print(f'=== PAGE {i+1} ===') print(text) print() " 2>&1 > /tmp/workspace/gi_content.txt wc -l /tmp/workspace/gi_content.txt echo "Done"

mkdir -p /tmp/workspace/gi-ppt && cat > /tmp/workspace/gi-ppt/build_ppt.py << 'PYEOF' 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 pptx.util import Inches, Pt import copy prs = Presentation() prs.slide_width = Inches(13.333) prs.slide_height = Inches(7.5) # ─── Color Palette ─────────────────────────────────────────────── DARK_BG = RGBColor(0x0A, 0x1A, 0x2E) # deep navy ACCENT1 = RGBColor(0x16, 0x78, 0xB4) # medical blue ACCENT2 = RGBColor(0x1A, 0xBC, 0x9C) # teal ACCENT3 = RGBColor(0xE7, 0x4C, 0x3C) # red highlight LIGHT_TEXT = RGBColor(0xFF, 0xFF, 0xFF) SUBTEXT = RGBColor(0xBD, 0xC3, 0xC7) YELLOW = RGBColor(0xF3, 0x9C, 0x12) LIGHT_BLUE = RGBColor(0xD6, 0xEA, 0xF8) DARK_CARD = RGBColor(0x17, 0x26, 0x40) BORDER_COL = RGBColor(0x22, 0x90, 0xD0) blank_layout = prs.slide_layouts[6] # fully blank def add_slide(): return prs.slides.add_slide(blank_layout) def fill_bg(slide, color=DARK_BG): from pptx.util import Inches bg = slide.shapes.add_shape(1, 0, 0, prs.slide_width, prs.slide_height) bg.fill.solid() bg.fill.fore_color.rgb = color bg.line.fill.background() def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_width=Pt(0)): shape = slide.shapes.add_shape(1, x, y, w, h) shape.fill.solid() shape.fill.fore_color.rgb = fill_color if line_color: shape.line.color.rgb = line_color shape.line.width = line_width else: shape.line.fill.background() return shape def add_text(slide, text, x, y, w, h, font_size=Pt(18), bold=False, color=LIGHT_TEXT, align=PP_ALIGN.LEFT, italic=False, wrap=True): tb = slide.shapes.add_textbox(x, y, w, h) tf = tb.text_frame tf.word_wrap = wrap tf.margin_left = 0; tf.margin_right = 0 tf.margin_top = 0; tf.margin_bottom = 0 p = tf.paragraphs[0] p.alignment = align run = p.add_run() run.text = text run.font.size = font_size run.font.bold = bold run.font.italic = italic run.font.color.rgb = color run.font.name = "Calibri" return tb def add_multiline_text(slide, lines, x, y, w, h, font_size=Pt(16), bold=False, color=LIGHT_TEXT, align=PP_ALIGN.LEFT, line_spacing=1.2, bullet=False): """lines = list of (text, bold, color, size) tuples OR plain strings""" tb = slide.shapes.add_textbox(x, y, w, h) tf = tb.text_frame tf.word_wrap = True tf.margin_left = Inches(0.05) tf.margin_right = Inches(0.05) tf.margin_top = Inches(0.05) tf.margin_bottom = Inches(0.05) first = True for item in lines: if isinstance(item, str): txt, b, c, sz = item, bold, color, font_size else: txt, b, c, sz = item if first: p = tf.paragraphs[0] first = False else: p = tf.add_paragraph() p.alignment = align run = p.add_run() run.text = ("• " if bullet else "") + txt run.font.size = sz run.font.bold = b run.font.color.rgb = c run.font.name = "Calibri" return tb def add_section_header(slide, title, subtitle=None): """Full-width top bar with title.""" add_rect(slide, 0, 0, prs.slide_width, Inches(1.15), ACCENT1) add_text(slide, title, Inches(0.4), Inches(0.12), Inches(12.5), Inches(0.7), font_size=Pt(30), bold=True, color=LIGHT_TEXT) if subtitle: add_text(slide, subtitle, Inches(0.4), Inches(0.78), Inches(12.5), Inches(0.35), font_size=Pt(15), color=LIGHT_BLUE) def add_divider_line(slide, y, color=ACCENT2, width_frac=0.92): w = int(prs.slide_width * width_frac) x = int(prs.slide_width * (1 - width_frac) / 2) line = slide.shapes.add_shape(1, x, y, w, Pt(2.5)) line.fill.solid() line.fill.fore_color.rgb = color line.line.fill.background() # ═══════════════════════════════════════════════════════════════════ # SLIDE 1 — TITLE # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) # top accent bar add_rect(s, 0, 0, prs.slide_width, Inches(0.12), ACCENT1) add_rect(s, 0, Inches(7.38), prs.slide_width, Inches(0.12), ACCENT2) # big vertical stripe left add_rect(s, 0, 0, Inches(0.9), prs.slide_height, ACCENT1) # teal inner stripe add_rect(s, Inches(0.9), 0, Inches(0.18), prs.slide_height, ACCENT2) # Title add_text(s, "GASTROINTESTINAL SYSTEM", Inches(1.3), Inches(1.4), Inches(11.5), Inches(1.3), font_size=Pt(40), bold=True, color=LIGHT_TEXT) add_text(s, "EXAMINATION", Inches(1.3), Inches(2.65), Inches(11.5), Inches(1.1), font_size=Pt(40), bold=True, color=ACCENT2) add_divider_line(s, Inches(3.82), ACCENT1) add_text(s, "A Systematic Approach for Postgraduate Clinical Practice", Inches(1.3), Inches(3.95), Inches(11.5), Inches(0.55), font_size=Pt(19), color=SUBTEXT, italic=True) add_text(s, "Reference: Archith Boloor — Insider's Guide to Clinical Medicine, 2020", Inches(1.3), Inches(5.4), Inches(11.5), Inches(0.4), font_size=Pt(13), color=SUBTEXT) add_text(s, "Department of Medicine", Inches(1.3), Inches(6.4), Inches(8), Inches(0.4), font_size=Pt(14), color=YELLOW, bold=True) # ═══════════════════════════════════════════════════════════════════ # SLIDE 2 — OUTLINE # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Outline", "Topics covered in this presentation") add_divider_line(s, Inches(1.18), ACCENT2) topics = [ ("1", "History Taking — GI System"), ("2", "General Examination"), ("3", "Head-to-Toe Signs of Liver Disease"), ("4", "Abdominal Inspection"), ("5", "Palpation — Liver, Spleen, Kidneys"), ("6", "Percussion Techniques"), ("7", "Auscultation"), ("8", "Cardinal Symptoms: Ascites, Pain, Jaundice, Dysphagia"), ("9", "Diagnosis Formats & Mnemonics"), ("10", "Per Rectal & Per Vaginal Examination"), ] cols = [topics[:5], topics[5:]] for ci, col in enumerate(cols): x = Inches(0.5 + ci * 6.4) for ri, (num, text) in enumerate(col): y = Inches(1.35 + ri * 1.1) add_rect(s, x, y, Inches(0.52), Inches(0.52), ACCENT1) add_text(s, num, x, y, Inches(0.52), Inches(0.52), font_size=Pt(18), bold=True, color=LIGHT_TEXT, align=PP_ALIGN.CENTER) add_text(s, text, x + Inches(0.6), y + Inches(0.06), Inches(5.6), Inches(0.45), font_size=Pt(17), color=LIGHT_TEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 3 — HISTORY TAKING # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "History Taking — GI System") add_divider_line(s, Inches(1.18), ACCENT2) # Two columns col1_items = [ ("Abdominal Distension", [ "Duration, Onset, Progression", "Aggravating / Relieving factors", "Preceded by / followed by pedal edema?", ]), ("Abdominal Pain", [ "Onset, Site, Type, Radiation", "Aggravating / Relieving factors", "Associated symptoms", ]), ("Nausea & Vomiting", [ "Episodes, Contents, Blood-tinged?", "Hours after food intake?", "Metabolic / Neurologic / Drug-induced / Psychogenic", ]), ] col2_items = [ ("Other GI Symptoms", [ "Heartburn, Flatulence, Waterbrash", "Hematemesis & Melena", "Dysphagia — solids > liquids vs liquids > solids", "Constipation / Diarrhea / Altered bowel habit", "Stool: color, odor, frequency, blood/melena", ]), ("Systemic Symptoms", [ "Jaundice — itching, high colored urine", "Fever, Weight loss", "Pain in oral cavity, Halitosis, Hiccups", ]), ("Key History", [ "Alcohol (units/week, duration)", "Medications: NSAIDs, steroids, antibiotics", "TB contact, DM, HTN, IHD", "Family Hx: 3-generation pedigree", ]), ] def draw_card_column(slide, items, x, col_w): y = Inches(1.3) for heading, bullets in items: card_h = Inches(0.38 + 0.32 * len(bullets)) add_rect(slide, x, y, col_w, card_h, DARK_CARD, BORDER_COL, Pt(1.2)) add_text(slide, heading, x + Inches(0.15), y + Inches(0.04), col_w - Inches(0.3), Inches(0.35), font_size=Pt(15), bold=True, color=ACCENT2) for bi, b in enumerate(bullets): add_text(slide, "• " + b, x + Inches(0.2), y + Inches(0.38 + bi * 0.30), col_w - Inches(0.3), Inches(0.30), font_size=Pt(12.5), color=SUBTEXT) y += card_h + Inches(0.1) draw_card_column(s, col1_items, Inches(0.25), Inches(6.3)) draw_card_column(s, col2_items, Inches(6.8), Inches(6.3)) # ═══════════════════════════════════════════════════════════════════ # SLIDE 4 — GENERAL EXAMINATION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "General Examination") add_divider_line(s, Inches(1.18), ACCENT2) boxes = [ ("Patient Assessment", ["Conscious, Coherent, Cooperative", "Obeying commands", "BMI = Weight(kg)/Height²(m)", "WHO Southeast Asian grading"]), ("Vitals", ["Pulse: Rate, Rhythm, Volume,\n Character, Vessel wall", "BP: All 4 limbs", "Respiratory Rate + Pattern", "JVP: cm above sternal angle"]), ("Physical Exam", ["Pallor", "Icterus", "Cyanosis", "Clubbing", "Lymphadenopathy", "Edema"]), ("Specific GI Signs", ["Jaundice (scleral icterus)", "Palmar erythema", "Spider naevi", "Dupuytren's contracture", "Leukonychia (Terry's nails)", "Fetor hepaticus"]), ("Endocrine (CLD)", ["Gynecomastia", "Testicular atrophy", "Loss of axillary/pubic hair", "Parotid enlargement", "Alopecia", "Irregular menses (F)"]), ("Other Signs", ["Caput medusae", "Umbilical hernia", "Flapping tremor (asterixis)", "Scratch marks (pruritus)", "Muscle wasting", "Peripheral edema"]), ] bw = Inches(4.1) bh = Inches(2.6) for i, (title, items) in enumerate(boxes): col = i % 3 row = i // 3 x = Inches(0.25 + col * 4.35) y = Inches(1.32 + row * 2.72) add_rect(s, x, y, bw, bh, DARK_CARD, BORDER_COL, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.38), ACCENT1) add_text(s, title, x + Inches(0.12), y + Inches(0.04), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=LIGHT_TEXT) for bi, bullet in enumerate(items): add_text(s, "• " + bullet, x + Inches(0.15), y + Inches(0.46 + bi * 0.33), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 5 — SIGNS OF CHRONIC LIVER DISEASE # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Head-to-Toe Signs of Chronic Liver Disease") add_divider_line(s, Inches(1.18), ACCENT2) regions = [ ("Head & Face", ["Alopecia", "Xanthelasma", "Parotid enlargement", "Icterus (scleral)", "Fetor hepaticus", "Diminished facial hair"]), ("Hands & Nails", ["Palmar erythema (liver palms)", "Dupuytren's contracture", "Leukonychia (Terry's nails)", "Muehrcke's nails", "Clubbing (PBC/hepatoma)", "Asterixis (flapping tremor)"]), ("Chest & Trunk", ["Spider naevi (>5 = significant)", "Gynecomastia", "Pectoral alopecia", "Loss of axillary hair", "Caput medusae", "Dilated chest veins"]), ("Abdomen", ["Hepatomegaly or shrunken liver", "Splenomegaly", "Ascites", "Caput medusae", "Umbilical hernia", "Abdominal wall veins"]), ("Lower Limbs", ["Pitting pedal edema", "Muscle wasting", "Peripheral neuropathy", "Scratch marks", "Purpura / ecchymosis", "Leukonychia"]), ("Genitalia", ["Testicular atrophy", "Loss of pubic hair", "Amenorrhea (females)", "Breast atrophy (females)", "Hyperestrogenic state", "Prader orchidometer for size"]), ] bw = Inches(4.1) bh = Inches(2.6) for i, (title, items) in enumerate(regions): col = i % 3 row = i // 3 x = Inches(0.25 + col * 4.35) y = Inches(1.32 + row * 2.72) add_rect(s, x, y, bw, bh, DARK_CARD, ACCENT2, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.38), ACCENT2) add_text(s, title, x + Inches(0.12), y + Inches(0.04), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=DARK_BG) for bi, bullet in enumerate(items): add_text(s, "• " + bullet, x + Inches(0.15), y + Inches(0.46 + bi * 0.33), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 6 — ABDOMINAL INSPECTION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Abdominal Inspection") add_divider_line(s, Inches(1.18), ACCENT2) # Position instruction box add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.55), ACCENT1) add_text(s, " Patient Position: Supine, arms by side, adequately exposed from xiphisternum to groin. Examiner on right side.", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.5), font_size=Pt(14), bold=True, color=LIGHT_TEXT) inspection_items = [ ("Shape & Contour", [ "Scaphoid (sunken) — malnutrition, malignancy", "Distended/protuberant — 7 Fs: Fat, Fluid, Flatus, Feces, Fetus, Full bladder, Fatal growth", "Asymmetry — organomegaly, masses", "Flanks fullness — ascites", ]), ("Skin & Surface", [ "Jaundice / icterus", "Caput medusae — dilated periumbilical veins (portal HTN)", "Striae (silvery = old; purple = Cushing's)", "Surgical scars — note all", "Visible peristalsis — intestinal obstruction", "Erythema ab igne", ]), ("Umbilicus", [ "Central / displaced (mass / ascites)", "Everted umbilicus — tense ascites", "Sister Mary Joseph nodule — metastatic malignancy", "Umbilical hernia", "Cullen's sign — periumbilical ecchymosis (acute pancreatitis)", "Grey Turner's sign — flank ecchymosis (retroperitoneal bleed)", ]), ("Measurements", [ "Abdominal girth (at umbilicus)", "Xiphisternum to umbilicus (X cm)", "Umbilicus to pubic symphysis (Y cm)", "Ratio X:Y — normal ~1; raised umbilicus in ascites", "Spino-umbilical distance", "Abdominal respiratory movement", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(inspection_items): col = i % 2 row = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.93 + row * 2.62) bh = Inches(0.4 + 0.35 * len(items)) add_rect(s, x, y, bw, bh, DARK_CARD, BORDER_COL, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.38), ACCENT1) add_text(s, title, x + Inches(0.12), y + Inches(0.04), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=LIGHT_TEXT) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.44 + bi * 0.33), bw - Inches(0.25), Inches(0.33), font_size=Pt(12), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 7 — PALPATION: GENERAL # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Abdominal Palpation") add_divider_line(s, Inches(1.18), ACCENT2) add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.52), DARK_CARD) add_text(s, " Warm hands, patient relaxed, knees slightly flexed. Start away from area of maximum tenderness. Both superficial and deep palpation.", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.47), font_size=Pt(13), color=YELLOW) sec_data = [ ("Superficial Palpation", Inches(0.25), Inches(1.9), Inches(4.05), [ "Assess tenderness, guarding, rigidity", "Skin turgor and temperature", "9 regions: RHC, epigastrium, LHC,\n R lumbar, umbilical, L lumbar,\n R iliac fossa, hypogastrium, L iliac fossa", ]), ("Deep Palpation", Inches(4.55), Inches(1.9), Inches(4.05), [ "Deep organs: liver, spleen, kidneys", "Masses: site, size, shape, surface,\n consistency, edge, mobility, tenderness", "Murphy's sign (gallbladder)", "Rovsing's sign, Psoas sign (appendix)", ]), ("Special Tests", Inches(8.85), Inches(1.9), Inches(4.25), [ "Murphy's sign: GB tenderness on inspiration", "McBurney's point tenderness (appendix)", "Rebound tenderness (peritonitis)", "Fluid thrill — large ascites", "Dipping method — palpate through ascites", "Ballottement — kidneys", ]), ] for title, x, y, w, items in sec_data: bh = Inches(0.4 + 0.45 * len(items)) add_rect(s, x, y, w, bh, DARK_CARD, ACCENT2, Pt(1.5)) add_rect(s, x, y, w, Inches(0.38), ACCENT2) add_text(s, title, x + Inches(0.12), y + Inches(0.04), w - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=DARK_BG) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.46 + bi * 0.43), w - Inches(0.25), Inches(0.41), font_size=Pt(12.5), color=SUBTEXT) # Hernia orifices add_rect(s, Inches(0.25), Inches(5.2), Inches(12.8), Inches(1.95), DARK_CARD, BORDER_COL, Pt(1)) add_text(s, "Hernia Orifices — Always Examine", Inches(0.4), Inches(5.25), Inches(6), Inches(0.35), font_size=Pt(14), bold=True, color=YELLOW) hernia_items = ["Inguinal (direct & indirect)", "Femoral", "Umbilical", "Incisional / paraumbilical", "Epigastric"] for hi, item in enumerate(hernia_items): col = hi % 3; row = hi // 3 x = Inches(0.4 + col * 4.2); y = Inches(5.68 + row * 0.35) add_text(s, "• " + item, x, y, Inches(4), Inches(0.32), font_size=Pt(13), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 8 — LIVER EXAMINATION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Liver Examination — Palpation Methods") add_divider_line(s, Inches(1.18), ACCENT2) liver_methods = [ ("1. Traditional Method", [ "Right hand on right iliac fossa, parallel to costal margin", "Keep hand steady during inspiration", "Feel liver edge as it descends with inspiration", "Move hand 1 cm upward during expiration if not felt", "Repeat until liver border is felt", ]), ("2. Preferred Method (Boloor)", [ "Sit on right side of patient, facing head end", "Both hands flat on abdomen, right subcostal region", "Fingers pointing toward ribs, lateral to rectus", "Exert gentle pressure — ask deep inspiration", "Feel border on fingertips; trace lateral → medial", ]), ("3. Alternate Method", [ "Right hand below and parallel to right subcostal margin", "Liver edge felt against radial border of index finger", ]), ("4. Hooking Method", [ "Examiner at right shoulder, facing foot end", "Curl fingertips under right costal margin", "Useful in obese patients", ]), ("5. Dipping Method (Ascites)", [ "Both hands one over the other", "Rapidly flex MCP joints — fingers dip into abdomen", "Displaces fluid — enhances palpation of organ", ]), ] y = Inches(1.3) for i, (title, items) in enumerate(liver_methods): bh = Inches(0.38 + 0.33 * len(items)) col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y_pos = Inches(1.32 + row_n * 2.3) if i < 4 else Inches(5.75) bw = Inches(6.2) if i < 4 else Inches(12.8) add_rect(s, x, y_pos, bw, bh, DARK_CARD, BORDER_COL, Pt(1)) add_rect(s, x, y_pos, bw, Inches(0.36), ACCENT1) add_text(s, title, x + Inches(0.12), y_pos + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=LIGHT_TEXT) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y_pos + Inches(0.42 + bi * 0.31), bw - Inches(0.25), Inches(0.30), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 9 — LIVER SPAN & CHARACTERISTICS # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Liver — Span, Surface & Characteristics") add_divider_line(s, Inches(1.18), ACCENT2) add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.52), DARK_CARD) add_text(s, " Normal liver span: 6–12 cm in right MCL. Upper border: 6th rib anteriorly. Lower border: crosses midline at transpyloric plane (L1).", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.47), font_size=Pt(13), color=YELLOW) span_items = [ ("Liver Span Measurement", [ "Upper border: heavy percussion → lung resonance to liver dullness", "Lower border: light percussion (heavy may underestimate)", "Normal span: 6–12 cm in right MCL", "Male > Female; tallest span", "Increased span: hepatomegaly, right pleural effusion", "Decreased span: cirrhosis (shrunken), acute hepatic necrosis", ]), ("Characteristics to Describe", [ "Size: cm below costal margin in MCL", "Shape: regular/irregular (cirrhosis = nodular)", "Surface: smooth / nodular / craggy", "Consistency: soft (normal/congestion) / firm (hepatitis) / hard (malignancy/cirrhosis)", "Edge: sharp (normal/fatty) / rounded (congestion) / irregular (malignancy)", "Tenderness: present/absent — direction", "Movement with respiration: yes/no", "Pulsatility: expansile (TR) vs transmitted", ]), ] for i, (title, items) in enumerate(span_items): x = Inches(0.25 + i * 6.55) bw = Inches(6.2) bh = Inches(0.38 + 0.34 * len(items)) add_rect(s, x, Inches(1.9), bw, bh, DARK_CARD, ACCENT2, Pt(1.2)) add_rect(s, x, Inches(1.9), bw, Inches(0.36), ACCENT2) add_text(s, title, x + Inches(0.12), Inches(1.93), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=DARK_BG) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), Inches(2.32 + bi * 0.34), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # Causes of hepatomegaly add_rect(s, Inches(0.25), Inches(5.55), Inches(12.8), Inches(1.7), DARK_CARD, BORDER_COL, Pt(1)) add_text(s, "Causes of Hepatomegaly", Inches(0.4), Inches(5.6), Inches(6), Inches(0.35), font_size=Pt(14), bold=True, color=YELLOW) causes = [ ("Infective", "Viral hepatitis, amoebic abscess, hydatid cyst, malaria, schistosomiasis"), ("Congestive", "Right heart failure, constrictive pericarditis, Budd-Chiari syndrome"), ("Infiltrative", "Fatty liver (NAFLD/alcohol), amyloidosis, glycogen storage disorders"), ("Malignant", "Hepatocellular carcinoma, metastases, lymphoma"), ("Obstructive", "Biliary cirrhosis, cholangiocarcinoma"), ] for ci, (cat, detail) in enumerate(causes): x = Inches(0.4 + ci * 2.5) add_text(s, cat, x, Inches(6.02), Inches(2.4), Inches(0.28), font_size=Pt(12), bold=True, color=ACCENT2) add_text(s, detail, x, Inches(6.3), Inches(2.4), Inches(0.7), font_size=Pt(10.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 10 — SPLEEN EXAMINATION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Spleen Examination") add_divider_line(s, Inches(1.18), ACCENT2) splenic_points = [ ("Position & Anatomy", [ "Lies in left hypochondrium and part of epigastrium", "Long axis along 10th rib", "Not normally palpable", "Must be 2–3× normal size to be palpable", "Direction of enlargement: toward right iliac fossa", ]), ("Palpation Technique", [ "Start from right iliac fossa, move toward left hypochondrium", "Bimanual palpation: right hand palpates, left hand supports left lower chest", "Ask patient to inspire deeply — splenic notch descends", "Feel for splenic notch (pathognomonic of spleen)", "Rollover position (right lateral decubitus) for small spleens", "Measure in Hackett's grade (I–V) or cm below costal margin", ]), ("Differentiating Spleen from Kidney", [ "Spleen: cannot get above it, has notch, moves with respiration", "Spleen: dull to percussion (Traube's space dull)", "Kidney: can get above it, ballottable, resonant anteriorly", "Kidney: not bimanually ballottable with notch", "Spleen: no round lower pole", ]), ("Causes of Splenomegaly", [ "Massive (>8 cm): malaria, kala-azar (visceral leish.), myelofibrosis, CML", "Moderate (4–8 cm): portal HTN, hemolytic anemia, lymphoma", "Mild (<4 cm): infections (typhoid, IE), RA (Felty's), SLE", "Hack's grading: I–V based on extent below costal margin", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(splenic_points): col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.32 + row_n * 2.85) bh = Inches(0.38 + 0.34 * len(items)) color = ACCENT1 if col == 0 else ACCENT2 add_rect(s, x, y, bw, bh, DARK_CARD, color, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), color) tc = LIGHT_TEXT if col == 0 else DARK_BG add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=tc) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.34), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 11 — KIDNEY EXAMINATION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Kidney Examination — Bimanual Palpation") add_divider_line(s, Inches(1.18), ACCENT2) add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.52), DARK_CARD) add_text(s, " Right kidney slightly lower than left. Normal kidneys not palpable except in thin individuals. Method: Bimanual (anterior + posterior hands).", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.47), font_size=Pt(13), color=YELLOW) kidney_boxes = [ ("Bimanual Palpation Technique", [ "Left hand (posterior): placed in right/left renal angle", "Right hand (anterior): over corresponding flank", "Exert firm upward pressure with posterior hand", "Anterior hand palpates during inspiration", "Ballottement: push up with posterior hand — feel tap on anterior", "Describe: size, shape, surface, consistency, tenderness", ]), ("Signs & Tests for Kidney", [ "Renal angle tenderness (CVA tenderness): fist percussion", "Ballottement: confirms kidney (not possible for spleen)", "Cannot insinuate hand above kidney (lower pole felt)", "Resonant to percussion anteriorly (bowel in front)", "Transillumination: hydronephrosis vs solid mass", ]), ("Renal vs Splenic Mass", [ "Renal: ballottable, resonant anteriorly, lower pole palpable", "Renal: can get hand between mass and costal margin sometimes", "Splenic: notch, moves diagonally, dull in Traube's space", "Splenic: cannot ballotte", ]), ("Causes of Renal Enlargement", [ "Unilateral: hydronephrosis, renal cell carcinoma, PCKD (early), pyonephrosis", "Bilateral: PCKD (adult), bilateral hydronephrosis, amyloidosis", "Simple cysts, angiomyolipoma", "Wilms' tumor (children)", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(kidney_boxes): col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.9 + row_n * 2.65) bh = Inches(0.38 + 0.34 * len(items)) add_rect(s, x, y, bw, bh, DARK_CARD, BORDER_COL, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), ACCENT1) add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=LIGHT_TEXT) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.34), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 12 — PERCUSSION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Abdominal Percussion") add_divider_line(s, Inches(1.18), ACCENT2) perc_boxes = [ ("Liver Percussion", [ "Upper border: 6th rib in MCL (heavy percussion technique)", "Lower border: light percussion (heavy overestimates)", "Liver span = upper to lower in right MCL", "Normal: 6–12 cm; dullness = liver", "Light's test: moving dullness at lower border", ]), ("Traube's Space", [ "Bounded by: left MCL (left), lower left ribs (right),\n 6th rib (top), left costal margin (bottom)", "Normally: tympanitic (gas-filled stomach)", "Dull Traube's space: splenomegaly, left pleural effusion,\n left-sided mass, full stomach", "Tympanitic Traube's: no splenomegaly", ]), ("Shifting Dullness (Ascites)", [ "Patient supine: percuss from umbilicus to flank", "Note transition from tympanic → dull", "Ask patient to roll to opposite side — wait 30 sec", "Re-percuss: dullness shifts to dependent side", "Detects >500 mL of ascites", "False positive: large ovarian cyst, distended bladder", ]), ("Fluid Thrill", [ "Detects large volumes (>1500 mL) of ascites", "Patient's hand (or assistant's) placed on midline", "Examiner flicks one flank and feels thrill on other", "Assistant's hand prevents transmission through fat", "More specific than shifting dullness for tense ascites", ]), ("Puddle Sign", [ "Patient prone for 5 minutes, then on hands and knees", "Stethoscope on most dependent point (umbilicus)", "Flick water drops into flanks — listen for dullness", "Detects as little as 120 mL of ascites", "Most sensitive test for small amounts of ascites", ]), ("Spleen Percussion", [ "Percuss Traube's space: tympanitic = likely no splenomegaly", "Nixon's method: left lateral decubitus; percuss from lower \nleft chest → midline", "Dullness >8 cm above costal margin = splenomegaly", "Splenomegaly confirmed by palpation", ]), ] bw = Inches(4.1) bh = Inches(2.58) for i, (title, items) in enumerate(perc_boxes): col = i % 3; row_n = i // 3 x = Inches(0.25 + col * 4.35) y = Inches(1.32 + row_n * 2.72) add_rect(s, x, y, bw, bh, DARK_CARD, ACCENT2, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), ACCENT2) add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(13.5), bold=True, color=DARK_BG) for bi, b in enumerate(items[:5]): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.41), bw - Inches(0.25), Inches(0.39), font_size=Pt(11.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 13 — AUSCULTATION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Abdominal Auscultation") add_divider_line(s, Inches(1.18), ACCENT2) auscultn = [ ("Bowel Sounds", [ "Normal: 5–30 clicks or gurgles per minute", "Auscultate for at least 60 seconds before declaring absent", "Hyperactive: gastroenteritis, early intestinal obstruction, diarrhea", "High-pitched tinkling: mechanical obstruction (intestinal hurry)", "Absent: paralytic ileus, late obstruction, peritonitis", "Borborygmi: loud rumbling — hunger, malabsorption", ]), ("Succussion Splash", [ "Produced by moving air and fluid in a hollow viscus", "Place stethoscope over epigastrium", "Shake patient's hips vigorously", "Normally absent >3 hours after meal", "Indicates: gastric outlet obstruction, pyloric stenosis,\n bowel obstruction", ]), ("Bruits", [ "Aortic bruit: midline epigastrium — aortic aneurysm / stenosis", "Renal bruit: above/below umbilicus laterally — renal artery stenosis", "Hepatic bruit: over liver — hepatocellular carcinoma, hepatic angioma", "Iliac bruit: lower abdominal quadrants", "Bruit + pulsatile mass = aneurysm (do NOT press hard)", ]), ("Venous Hum", [ "Low-pitched, continuous hum", "Site: periumbilical region / right upper quadrant", "Cruveilhier-Baumgarten syndrome: venous hum at umbilicus\n in portal hypertension with recanalised umbilical vein", "Hepatic venous hum: Budd-Chiari syndrome", ]), ("Friction Rub", [ "High-pitched scratchy sound with respiration", "Hepatic rub: over liver — hepatocellular carcinoma,\n hepatic abscess, liver biopsy site", "Splenic rub: over spleen — splenic infarct, perisplenitis", "Peritoneal rub: peritonitis, ovarian tumor", ]), ] bw = Inches(12.8) for i, (title, items) in enumerate(auscultn): y = Inches(1.32 + i * 1.15) bh = Inches(1.1) add_rect(s, Inches(0.25), y, bw, bh, DARK_CARD, BORDER_COL, Pt(1)) add_rect(s, Inches(0.25), y, Inches(2.2), bh, ACCENT1) add_text(s, title, Inches(0.35), y + Inches(0.3), Inches(2.0), Inches(0.5), font_size=Pt(13.5), bold=True, color=LIGHT_TEXT, align=PP_ALIGN.CENTER) # bullets in 2 columns for bi, b in enumerate(items[:3]): add_text(s, "• " + b, Inches(2.55), y + Inches(0.08 + bi * 0.33), Inches(5.2), Inches(0.32), font_size=Pt(11.5), color=SUBTEXT) for bi, b in enumerate(items[3:]): add_text(s, "• " + b, Inches(7.9), y + Inches(0.08 + bi * 0.33), Inches(5.0), Inches(0.32), font_size=Pt(11.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 14 — ASCITES # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Cardinal Symptom: Ascites") add_divider_line(s, Inches(1.18), ACCENT2) # 7 Fs add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.55), ACCENT1) add_text(s, " 7 Fs of Abdominal Distension: Fat | Fluid | Flatus | Feces | Fetus | Full bladder | Fatal growth (neoplasm)", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.5), font_size=Pt(14), bold=True, color=LIGHT_TEXT) asc_cols = [ ("Causes of Ascites", [ "Cirrhosis (most common in India)", "Malignancy (peritoneal carcinomatosis, ovarian ca)", "Tuberculosis (peritoneal TB)", "Right heart failure / constrictive pericarditis", "Nephrotic syndrome, severe hypoalbuminemia", "Budd-Chiari syndrome", "Pancreatitis (pancreatic ascites)", "Meig's syndrome", ]), ("SAAG — Serum-Ascites Albumin Gradient", [ "SAAG = Serum albumin − Ascites albumin", "High SAAG (≥1.1 g/dL): portal hypertension", " → Cirrhosis, CCF, Budd-Chiari, alcoholic hepatitis", "Low SAAG (<1.1 g/dL): non-portal HTN", " → TB, malignancy, nephrotic, pancreatitis", "SAAG preferred over exudate/transudate classification", "Accuracy ~97% for portal hypertension", ]), ("Tests for Ascites", [ "Shifting dullness: >500 mL (most sensitive on exam)", "Fluid thrill: >1500 mL (tense ascites)", "Puddle sign: ≥120 mL (most sensitive)", "Ultrasound abdomen: gold standard (20 mL detectable)", "Paracentesis: diagnostic + therapeutic", "Ascitic fluid: appearance, cell count, protein,\n LDH, glucose, culture, cytology", ]), ] bw = Inches(4.1) for i, (title, items) in enumerate(asc_cols): x = Inches(0.25 + i * 4.35) bh = Inches(0.38 + 0.35 * len(items)) add_rect(s, x, Inches(1.93), bw, bh, DARK_CARD, ACCENT2, Pt(1.2)) add_rect(s, x, Inches(1.93), bw, Inches(0.36), ACCENT2) add_text(s, title, x + Inches(0.12), Inches(1.96), bw - Inches(0.2), Inches(0.32), font_size=Pt(13.5), bold=True, color=DARK_BG) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), Inches(2.35 + bi * 0.35), bw - Inches(0.25), Inches(0.34), font_size=Pt(12), color=SUBTEXT) # Portal hypertension note add_rect(s, Inches(0.25), Inches(5.55), Inches(12.8), Inches(1.7), DARK_CARD, BORDER_COL, Pt(1)) add_text(s, "Portal Hypertension Features", Inches(0.4), Inches(5.62), Inches(5), Inches(0.35), font_size=Pt(14), bold=True, color=YELLOW) ph_items = [ "Splenomegaly + ascites", "Caput medusae (periumbilical collaterals)", "Dilated abdominal wall veins: flow AWAY from umbilicus", "Hemorrhoids (anorectal varices)", "Oesophageal / gastric varices (presenting as UGI bleed)", "Cruveilhier-Baumgarten venous hum", "Portal hypertensive gastropathy", ] for ci, item in enumerate(ph_items): col = ci % 4; row_n = ci // 4 x = Inches(0.4 + col * 3.15); y = Inches(6.05 + row_n * 0.38) add_text(s, "• " + item, x, y, Inches(3.1), Inches(0.36), font_size=Pt(12), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 15 — JAUNDICE # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Cardinal Symptom: Jaundice") add_divider_line(s, Inches(1.18), ACCENT2) jaundice_data = [ ("Pre-hepatic (Hemolytic)", ACCENT3, [ "Elevated unconjugated bilirubin", "Dark urine: absent (bilirubin not water-soluble)", "Stools: pale stools — NOT seen here (dark)", "Urobilinogen in urine: markedly increased", "LFTs: normal AST/ALT", "Splenomegaly common", "Examples: hemolytic anemia, G6PD deficiency,\nsickle cell, malaria, spherocytosis", ]), ("Hepatic (Hepatocellular)", YELLOW, [ "Both conjugated + unconjugated elevated", "Urine: dark (conjugated bilirubin passes through)", "Stools: pale (reduced bile excretion)", "Urobilinogen: variable", "LFTs: elevated AST/ALT (hepatocyte damage)", "Prothrombin time: prolonged", "Examples: viral hepatitis, cirrhosis, alcohol,\nDrug-induced, Wilson's disease, autoimmune", ]), ("Post-hepatic (Obstructive)", ACCENT2, [ "Elevated conjugated bilirubin", "Urine: dark (bilirubinuria) — tea-colored", "Stools: clay-colored / pale (bile absent)", "Urobilinogen: absent in urine", "Pruritus (bile salts deposition in skin)", "ALP / GGT elevated", "Examples: cholelithiasis, pancreatic Ca (Courvoisier's),\ncholangiocarcinoma, primary sclerosing cholangitis", ]), ] for i, (title, color, items) in enumerate(jaundice_data): x = Inches(0.25 + i * 4.35) bw = Inches(4.1) bh = Inches(5.45) add_rect(s, x, Inches(1.28), bw, bh, DARK_CARD, color, Pt(2)) add_rect(s, x, Inches(1.28), bw, Inches(0.42), color) add_text(s, title, x + Inches(0.1), Inches(1.3), bw - Inches(0.2), Inches(0.37), font_size=Pt(14), bold=True, color=DARK_BG if color == YELLOW or color == ACCENT2 else LIGHT_TEXT) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), Inches(1.78 + bi * 0.55), bw - Inches(0.25), Inches(0.52), font_size=Pt(12.5), color=SUBTEXT) # Courvoisier's law add_rect(s, Inches(0.25), Inches(6.82), Inches(12.8), Inches(0.5), DARK_CARD) add_text(s, "Courvoisier's Law: A palpable, non-tender GB with jaundice is unlikely to be due to gallstones — think malignancy (pancreatic / cholangiocarcinoma). Exception: double stone impaction.", Inches(0.4), Inches(6.84), Inches(12.3), Inches(0.45), font_size=Pt(12.5), color=YELLOW, italic=True) # ═══════════════════════════════════════════════════════════════════ # SLIDE 16 — DYSPHAGIA # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Cardinal Symptom: Dysphagia") add_divider_line(s, Inches(1.18), ACCENT2) add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.52), DARK_CARD) add_text(s, " Dysphagia (Greek: dys = difficulty, phagia = to eat) — sensation of food hindered in passage from mouth to stomach", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.47), font_size=Pt(13), color=YELLOW, italic=True) dysph_cols = [ ("Oropharyngeal Dysphagia", [ "Difficulty initiating swallow", "Nasal regurgitation, aspiration, choking", "Neuromuscular: ALS, MS, MG, Parkinson's, Polymyositis, Stroke", "Structural: Carcinoma, Zenker's diverticulum, \nPlummer-Vinson syndrome, osteophytes", ]), ("Esophageal Dysphagia", [ "Motility disorders: Achalasia, Diffuse esophageal spasm,\n Scleroderma", "Structural (intrinsic): Carcinoma, peptic stricture, \nSchatzki's ring, web", "Extrinsic compression: Vascular rings, mediastinal mass,\n dysphagia lusoria", "Progressive solids > liquids → carcinoma/stricture", "Solids + liquids from onset → motility disorder", ]), ("Key Clinical Questions", [ "Onset and progression (progressive vs intermittent)", "Solids only → structural (mechanical obstruction)", "Solids + liquids → motility disorder", "Weight loss suggests malignancy", "Heartburn / regurgitation → GERD-related stricture", "Duration / associated symptoms (regurgitation, pain)", "Night symptoms: achalasia (aspiration at night)", "Previous surgery or radiation history", ]), ("Investigations", [ "Barium swallow: 1st line — shows filling defect, stricture", "Achalasia: 'bird's beak' or 'rat-tail' narrowing at LES", "Upper GI endoscopy + biopsy: gold standard for malignancy", "Esophageal manometry: gold standard for motility", "24-hr pH monitoring: GERD assessment", "CT thorax/abdomen: extrinsic compression", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(dysph_cols): col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.9 + row_n * 2.65) bh = Inches(0.38 + 0.34 * len(items)) add_rect(s, x, y, bw, bh, DARK_CARD, BORDER_COL, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), ACCENT1) add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=LIGHT_TEXT) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.34), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 17 — GI BLEED # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "GI Bleeding — Hematemesis & Melena") add_divider_line(s, Inches(1.18), ACCENT2) gi_bleed = [ ("Hematemesis — UGI Bleed", [ "Blood vomited: red (fresh, brisk) or coffee-ground (older, digested)", "Source: proximal to ligament of Treitz", "Common causes: peptic ulcer (most common), varices (portal HTN),\n Mallory-Weiss tear, erosive gastritis, Dieulafoy's lesion, GAVE", "Varices: painless, profuse; associated signs of CLD", "Peptic ulcer: epigastric pain, NSAIDs/H. pylori history", "Rockall score / Glasgow-Blatchford: risk stratification", ]), ("Melena", [ "Black, tarry, offensive-smelling stool", "Requires ≥60 mL blood loss from upper GI tract", "Blood altered by gastric acid and bacterial action", "Indicates digested blood — upper GI source usually", "Can occur with right-sided colonic or ileal bleed (slow transit)", "Distinguish from iron/bismuth (black, non-tarry, no smell)", ]), ("Hematochezia", [ "Bright red blood per rectum", "Usually lower GI source (colon, rectum, anus)", "Massive UGI bleed can also cause hematochezia", "Common causes: hemorrhoids, colorectal carcinoma,\n diverticular disease, IBD, ischemic colitis, angiodysplasia", "Colonoscopy: gold standard for lower GI source", ]), ("Investigations", [ "Urgent FBC, coagulation, LFTs, BUN/Creatinine", "BUN:Cr ratio >20: suggests UGI bleed", "Upper endoscopy: investigation of choice for UGI bleed", "Colonoscopy: for lower GI bleed", "CT angiography: active bleed (>0.5 mL/min detectable)", "Technetium-labeled RBC scan: 0.1 mL/min detectable", "Capsule endoscopy: obscure GI bleed", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(gi_bleed[:4]): col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.32 + row_n * 2.95) bh = Inches(0.38 + 0.34 * len(items)) color = ACCENT3 if i == 0 else (ACCENT2 if i == 1 else (YELLOW if i == 2 else ACCENT1)) add_rect(s, x, y, bw, bh, DARK_CARD, color, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), color) tc = LIGHT_TEXT if color == ACCENT3 or color == ACCENT1 else DARK_BG add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=tc) for bi, b in enumerate(items[:5]): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.34), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 18 — PER RECTAL EXAMINATION # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Per Rectal (PR) & Per Vaginal (PV) Examination") add_divider_line(s, Inches(1.18), ACCENT2) add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.52), DARK_CARD) add_text(s, " PR examination is mandatory in any patient with change in bowel habits, rectal bleeding, suspected pelvic pathology, or unexplained anemia.", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.47), font_size=Pt(13), color=YELLOW) pr_boxes = [ ("Indications", [ "Rectal bleeding / melena", "Altered bowel habits", "Anorectal pain / discharge", "Suspected colorectal carcinoma", "Prostate assessment", "Fecal impaction", "Suspected appendicitis", "Pelvic floor assessment", ]), ("Technique", [ "Explain and obtain consent", "Left lateral position (or knee-chest)", "Inspect perianal area first (fissures, fistulae, hemorrhoids, skin tags)", "Lubricate gloved right index finger", "Gently insert finger into rectum", "Palpate circumferentially — all 4 walls", "Assess tone of sphincter", "Withdraw and inspect glove", ]), ("Findings", [ "Feces: hard (constipation), blood, mucus", "Masses: site, size, consistency, mobility, tenderness", "Rectal wall: smooth, nodular, ulcerated", "Prostate (male): size, consistency, median sulcus", "Cervix (female): palpable anteriorly", "Boggy mass / tenderness: abscess, pelvic collection", "Blood on glove: active bleeding or higher lesion", ]), ("Prostatic Findings", [ "Normal prostate: walnut-sized, smooth, elastic, median sulcus", "BPH: uniformly enlarged, smooth, rubbery", "Prostate Ca: hard, nodular, loss of median sulcus", "Prostatitis: tender, boggy, warm", "Prostate size grading: Grade I–IV", "DRE: sensitivity ~50% for prostate Ca", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(pr_boxes): col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.9 + row_n * 2.65) bh = Inches(0.38 + 0.35 * len(items)) add_rect(s, x, y, bw, bh, DARK_CARD, ACCENT1, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), ACCENT1) add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=LIGHT_TEXT) for bi, b in enumerate(items[:7]): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.33), bw - Inches(0.25), Inches(0.33), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 19 — DIAGNOSIS FORMAT: CIRRHOSIS # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Diagnosis Format — Chronic Liver Disease / Cirrhosis") add_divider_line(s, Inches(1.18), ACCENT2) add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.55), DARK_CARD) add_text(s, " Example: Decompensated chronic liver disease — cirrhosis secondary to alcohol, with portal hypertension, UGI bleed, hepatic encephalopathy Stage 2", Inches(0.3), Inches(1.3), Inches(12.5), Inches(0.5), font_size=Pt(13), color=YELLOW, italic=True) diag_boxes = [ ("Step 1: Acuity", [ "Acute hepatitis (<4 weeks)", "Subacute hepatitis (4–12 weeks)", "Chronic liver disease (>6 months)", "Acute on chronic liver disease (ACLD)", ]), ("Step 2: Compensation", [ "Compensated: no jaundice, ascites, encephalopathy", "Decompensated: any of the above present", "Child-Pugh score: A (5–6), B (7–9), C (10–15)", "MELD score: predicts 90-day mortality", ]), ("Step 3: Etiology", [ "Alcohol (AUDIT questionnaire)", "Viral: HBV (HBsAg), HCV (anti-HCV)", "NASH / NAFLD (metabolic syndrome)", "Autoimmune hepatitis (ANA, ASMA)", "Wilson's disease (ceruloplasmin, KF rings)", "Hemochromatosis (transferrin saturation, HFE gene)", "Primary biliary cirrhosis (AMA)", ]), ("Step 4: Complications", [ "Portal hypertension with/without GI bleed", "Hepatic encephalopathy (Grade I–IV: West Haven)", "Spontaneous bacterial peritonitis (SBP)", "Hepatocellular carcinoma (AFP, imaging)", "Hepatorenal syndrome (Type I / II)", "Hepatopulmonary syndrome", "Portopulmonary hypertension", ]), ] bw = Inches(6.2) for i, (title, items) in enumerate(diag_boxes): col = i % 2; row_n = i // 2 x = Inches(0.25 + col * 6.55) y = Inches(1.93 + row_n * 2.6) bh = Inches(0.38 + 0.36 * len(items)) add_rect(s, x, y, bw, bh, DARK_CARD, ACCENT2, Pt(1.2)) add_rect(s, x, y, bw, Inches(0.36), ACCENT2) add_text(s, title, x + Inches(0.12), y + Inches(0.03), bw - Inches(0.2), Inches(0.32), font_size=Pt(14), bold=True, color=DARK_BG) for bi, b in enumerate(items): add_text(s, "• " + b, x + Inches(0.15), y + Inches(0.42 + bi * 0.35), bw - Inches(0.25), Inches(0.34), font_size=Pt(12.5), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 20 — IMPORTANT EPONYMS & MNEMONICS # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Important Eponyms & Mnemonics in GI Examination") add_divider_line(s, Inches(1.18), ACCENT2) epo_list = [ ("Courvoisier's Law", "Palpable non-tender GB + jaundice → NOT gallstones → malignancy"), ("Murphy's Sign", "Arrest of inspiration during deep palpation of RHC → acute cholecystitis"), ("Cullen's Sign", "Periumbilical ecchymosis → acute pancreatitis / ruptured ectopic"), ("Grey Turner's Sign", "Flank ecchymosis → retroperitoneal bleed (acute pancreatitis)"), ("Cruveilhier-Baumgarten", "Venous hum at umbilicus → portal HTN (recanalised umbilical vein)"), ("Sister Mary Joseph Nodule", "Umbilical nodule → intraabdominal / pelvic malignancy metastasis"), ("Virchow's Node", "Hard left supraclavicular LN → gastric/other abdominal malignancy"), ("Rovsing's Sign", "Pressure on LIF → pain in RIF → acute appendicitis"), ("Carnett's Sign", "Tensing abdominal wall → pain increases → abdominal wall pain"), ("Psoas Sign", "Pain on extension of right hip → retrocaecal appendicitis"), ("Obturator Sign", "Pain on internal rotation of right hip → pelvic appendicitis"), ("McBurney's Point", "1/3 distance from ASIS to umbilicus → site of appendix tenderness"), ("Dance's Sign", "Empty RIF → intussusception"), ("Blumer's Shelf", "Mass felt on PR in rectovesical pouch → peritoneal metastases"), ("Troisier's Sign", "Palpable Virchow's node → Troisier = Virchow's eponym in Europe"), ] # 3-column table layout add_rect(s, Inches(0.25), Inches(1.28), Inches(12.8), Inches(0.38), DARK_CARD) add_text(s, "Sign / Eponym", Inches(0.35), Inches(1.3), Inches(3.5), Inches(0.35), font_size=Pt(13), bold=True, color=ACCENT2) add_text(s, "Significance", Inches(4.0), Inches(1.3), Inches(8.8), Inches(0.35), font_size=Pt(13), bold=True, color=ACCENT2) for i, (sign, meaning) in enumerate(epo_list): y = Inches(1.72 + i * 0.35) bg = DARK_CARD if i % 2 == 0 else RGBColor(0x12, 0x20, 0x38) add_rect(s, Inches(0.25), y, Inches(12.8), Inches(0.34), bg) add_text(s, sign, Inches(0.35), y + Inches(0.02), Inches(3.55), Inches(0.3), font_size=Pt(12), bold=True, color=ACCENT2 if i % 2 == 0 else LIGHT_TEXT) add_text(s, meaning, Inches(4.0), y + Inches(0.02), Inches(8.8), Inches(0.3), font_size=Pt(12), color=SUBTEXT) # ═══════════════════════════════════════════════════════════════════ # SLIDE 21 — SUMMARY / TAKE-HOME # ═══════════════════════════════════════════════════════════════════ s = add_slide() fill_bg(s) add_section_header(s, "Summary — Systematic GI Examination") add_divider_line(s, Inches(1.18), ACCENT2) steps = [ ("1", "HISTORY", "Pain, Distension, Nausea/Vomiting, Dysphagia, Altered bowel habit, Jaundice, Bleed", ACCENT1), ("2", "GENERAL EXAM", "BMI, Pallor, Icterus, CLD signs (palmar erythema, spider naevi, Dupuytren's, leukonychia, asterixis)", ACCENT2), ("3", "INSPECTION", "Contour, Skin, Umbilicus, Veins, Scars, Visible peristalsis, Abdominal girth measurements", ACCENT1), ("4", "PALPATION", "Superficial → Deep. Liver (5 methods), Spleen (start RIF), Kidneys (bimanual), Hernia orifices", ACCENT2), ("5", "PERCUSSION", "Liver span, Traube's space, Shifting dullness, Fluid thrill, Puddle sign for ascites", ACCENT1), ("6", "AUSCULTATION", "Bowel sounds (60 sec), Succussion splash, Bruits, Venous hum, Friction rub", ACCENT2), ("7", "SPECIAL EXAMS", "PR examination (mandatory), PV if indicated, Supraclavicular nodes, Scrotum, Spine", ACCENT1), ("8", "DIAGNOSIS", "Acuity → Compensation → Etiology → Complications (Step 1 → 4)", ACCENT2), ] for i, (num, stage, detail, color) in enumerate(steps): y = Inches(1.32 + i * 0.72) add_rect(s, Inches(0.25), y, Inches(12.8), Inches(0.68), DARK_CARD) add_rect(s, Inches(0.25), y, Inches(0.55), Inches(0.68), color) add_text(s, num, Inches(0.25), y + Inches(0.08), Inches(0.55), Inches(0.5), font_size=Pt(18), bold=True, color=LIGHT_TEXT, align=PP_ALIGN.CENTER) add_text(s, stage, Inches(0.85), y + Inches(0.16), Inches(2.3), Inches(0.38), font_size=Pt(14), bold=True, color=color) add_text(s, detail, Inches(3.3), y + Inches(0.16), Inches(9.55), Inches(0.38), font_size=Pt(13), color=SUBTEXT) # ref line add_rect(s, Inches(0.25), Inches(7.15), Inches(12.8), Inches(0.28), DARK_CARD) add_text(s, "Reference: Archith Boloor — Insider's Guide to Clinical Medicine, 2020 | Department of Medicine — PG Teaching", Inches(0.35), Inches(7.17), Inches(12.3), Inches(0.25), font_size=Pt(11), color=SUBTEXT, italic=True) # ─── SAVE ──────────────────────────────────────────────────────── out = "/tmp/workspace/gi-ppt/GI_System_Examination_PG.pptx" prs.save(out) print(f"Saved: {out}") print(f"Slides: {len(prs.slides)}") PYEOF python3 /tmp/workspace/gi-ppt/build_ppt.py

python3 -c " from pptx import Presentation prs = Presentation('/tmp/workspace/gi-ppt/GI_System_Examination_PG.pptx') print(f'Total slides: {len(prs.slides)}') for i, slide in enumerate(prs.slides, 1): texts = [sh.text_frame.text[:60] for sh in slide.shapes if sh.has_text_frame and sh.text_frame.text.strip()] print(f'Slide {i}: {texts[:2]}') "

cd /tmp/workspace && python3 -c " import pdfplumber pdf_path = '/tmp/workspace/attachments/608e9b59-171c-4f6a-ad2b-c1ad1c638dd7/Archith Boloor insiders guide to clinical medicine 2020_compressed.pdf' with pdfplumber.open(pdf_path) as pdf: # Extract detailed examination pages - GI chapter thoroughly for i in range(240, 360): text = pdf.pages[i].extract_text() if text: print(f'=== PAGE {i+1} ===') print(text) print() " 2>&1 > /tmp/workspace/gi_full.txt wc -l /tmp/workspace/gi_full.txt echo 'Done'