SRB Clinical Surgery S.R. Bansal chapter list contents summary

mkdir -p /tmp/workspace/srb-surgery && ls /tmp/workspace/srb-surgery/

mkdir -p /tmp/workspace/srb-surgery && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm, mm from reportlab.lib import colors from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak, KeepTogether) from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate from reportlab.pdfgen import canvas OUTPUT = "/tmp/workspace/srb-surgery/SRB_Clinical_Surgery_StudyNotes.pdf" # ── Page layout ────────────────────────────────────────────────────────────── doc = SimpleDocTemplate( OUTPUT, pagesize=A4, leftMargin=2*cm, rightMargin=2*cm, topMargin=2.5*cm, bottomMargin=2.5*cm, title="SRB Clinical Surgery – Complete Study Notes", author="Orris Medical AI" ) W, H = A4 # ── Colour palette ──────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1a3a5c") TEAL = colors.HexColor("#0077b6") LTBLUE = colors.HexColor("#90e0ef") GREEN = colors.HexColor("#2d6a4f") ORANGE = colors.HexColor("#e76f51") YELLOW = colors.HexColor("#fff3cd") LGREY = colors.HexColor("#f0f4f8") WHITE = colors.white # ── Styles ──────────────────────────────────────────────────────────────────── styles = getSampleStyleSheet() def S(name, **kw): return ParagraphStyle(name, **kw) COVER_TITLE = S("CoverTitle", fontSize=32, textColor=WHITE, alignment=TA_CENTER, spaceAfter=8, fontName="Helvetica-Bold", leading=38) COVER_SUB = S("CoverSub", fontSize=16, textColor=LTBLUE, alignment=TA_CENTER, spaceAfter=6, fontName="Helvetica", leading=20) COVER_INFO = S("CoverInfo", fontSize=12, textColor=WHITE, alignment=TA_CENTER, spaceAfter=4, fontName="Helvetica") CH_TITLE = S("ChTitle", fontSize=18, textColor=WHITE, alignment=TA_CENTER, fontName="Helvetica-Bold", leading=22, spaceAfter=4) SEC_HEAD = S("SecHead", fontSize=13, textColor=NAVY, fontName="Helvetica-Bold", spaceBefore=10, spaceAfter=4, leading=16) SUBSEC = S("SubSec", fontSize=11, textColor=TEAL, fontName="Helvetica-Bold", spaceBefore=6, spaceAfter=3, leading=14) BODY = S("Body", fontSize=9.5, fontName="Helvetica", leading=14, spaceAfter=3, textColor=colors.HexColor("#1a1a2e")) BULLET = S("Bullet", fontSize=9.5, fontName="Helvetica", leading=14, leftIndent=14, spaceAfter=2, bulletIndent=4, textColor=colors.HexColor("#1a1a2e")) SUBBULLET = S("SubBullet", fontSize=9, fontName="Helvetica", leading=13, leftIndent=28, spaceAfter=2, bulletIndent=14, textColor=colors.HexColor("#444444")) NOTE = S("Note", fontSize=9, fontName="Helvetica-Oblique", leading=13, textColor=GREEN, leftIndent=10) KEYPOINT = S("Keypoint", fontSize=9.5, fontName="Helvetica-Bold", leading=14, textColor=ORANGE) def B(text): return f"<b>{text}</b>" def I(text): return f"<i>{text}</i>" # ── Helper builders ─────────────────────────────────────────────────────────── def chap_banner(title, color=NAVY): data = [[Paragraph(title, CH_TITLE)]] t = Table(data, colWidths=[17*cm]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), color), ("ROUNDEDCORNERS", [6]), ("TOPPADDING", (0,0), (-1,-1), 10), ("BOTTOMPADDING", (0,0), (-1,-1), 10), ("LEFTPADDING", (0,0), (-1,-1), 12), ])) return t def section_box(title, items, bg=LGREY, accent=TEAL): """Items = list of strings (bullet points).""" header = [[Paragraph(f"<font color='white'><b>{title}</b></font>", S("TH", fontSize=10, fontName="Helvetica-Bold", textColor=WHITE, leading=14))]] ht = Table(header, colWidths=[17*cm]) ht.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), accent), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 10), ])) rows = [] for item in items: if item.startswith(">>"): rows.append([Paragraph(f" \u2514\u2500 {item[2:].strip()}", SUBBULLET)]) else: rows.append([Paragraph(f"\u2022 {item}", BULLET)]) bt = Table(rows, colWidths=[17*cm]) bt.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), bg), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 8), ])) return [ht, bt, Spacer(1, 4)] def key_box(text): data = [[Paragraph(f"<b>KEY POINT:</b> {text}", S("KP", fontSize=9.5, fontName="Helvetica", leading=14, textColor=colors.HexColor("#7b2d00")))]] t = Table(data, colWidths=[17*cm]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), colors.HexColor("#fff3cd")), ("BOX", (0,0), (-1,-1), 1, colors.HexColor("#e76f51")), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 10), ])) return [t, Spacer(1, 5)] def two_col_table(left_head, right_head, rows_data, accent=TEAL): header = [[Paragraph(f"<b><font color='white'>{left_head}</font></b>", S("TH2L", fontSize=9.5, fontName="Helvetica-Bold", leading=13)), Paragraph(f"<b><font color='white'>{right_head}</font></b>", S("TH2R", fontSize=9.5, fontName="Helvetica-Bold", leading=13))]] all_rows = header for r in rows_data: all_rows.append([Paragraph(r[0], BULLET), Paragraph(r[1], BODY)]) t = Table(all_rows, colWidths=[6*cm, 11*cm]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), accent), ("BACKGROUND", (0,1), (-1,-1), LGREY), ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LGREY]), ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#cccccc")), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ("VALIGN", (0,0), (-1,-1), "TOP"), ])) return [t, Spacer(1, 6)] def hr(): return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#cccccc")) # ═══════════════════════════════════════════════════════════════════════════════ # CONTENT # ═══════════════════════════════════════════════════════════════════════════════ story = [] # ─── COVER PAGE ─────────────────────────────────────────────────────────────── cover_bg = [[Paragraph("SRB's CLINICAL SURGERY", COVER_TITLE)]] ct = Table(cover_bg, colWidths=[17*cm]) ct.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), NAVY), ("TOPPADDING", (0,0), (-1,-1), 40), ("BOTTOMPADDING", (0,0), (-1,-1), 40), ("LEFTPADDING", (0,0), (-1,-1), 10), ])) story.append(ct) story.append(Spacer(1, 0.3*cm)) sub_data = [[Paragraph("COMPLETE STUDY NOTES", COVER_SUB)]] st = Table(sub_data, colWidths=[17*cm]) st.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), TEAL), ("TOPPADDING", (0,0), (-1,-1), 10), ("BOTTOMPADDING", (0,0), (-1,-1), 10), ])) story.append(st) story.append(Spacer(1, 0.5*cm)) story.append(Paragraph("All Major Chapters | Bullet-Point Format | Exam-Ready", S("DS", fontSize=12, textColor=NAVY, alignment=TA_CENTER, fontName="Helvetica-Oblique"))) story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("Based on SRB's Manual of Surgery (Sriram Bhat M.) – 6th/Latest Edition", S("DS2", fontSize=10, textColor=colors.HexColor("#555555"), alignment=TA_CENTER))) story.append(Spacer(1, 1*cm)) # TOC preview toc_items = [ ("Ch 1", "General Surgery Principles (Wounds, Ulcers, Shock, Burns, Trauma)"), ("Ch 2-4", "Faciomaxillary, Oral Cavity, Salivary Glands"), ("Ch 5", "Neck"), ("Ch 6-7", "Thyroid & Parathyroid"), ("Ch 8", "Breast"), ("Ch 9", "Thorax & Lungs"), ("Ch 10-11","Oesophagus & Stomach"), ("Ch 12", "Small Intestine & Appendix"), ("Ch 13-14","Large Intestine, Rectum & Anus"), ("Ch 15-16","Liver, Biliary System & Pancreas"), ("Ch 17", "Spleen"), ("Ch 18-19","Hernias & Abdominal Wall"), ("Ch 20-21","Vascular Surgery (Arterial & Venous)"), ("Ch 22-23","Urology (Kidney, Bladder, Prostate)"), ("Ch 24-25","Male Genitalia & Endocrine Surgery"), ("Ch 26-27","Neurosurgery & Orthopaedics"), ("Ch 28-33","Trauma, Burns, Transplantation, Oncology, Pre/Postop Care"), ] toc_rows = [] for ch, title in toc_items: toc_rows.append([Paragraph(f"<b>{ch}</b>", S("T1", fontSize=9.5, fontName="Helvetica-Bold", textColor=TEAL)), Paragraph(title, BODY)]) toc_t = Table([[Paragraph("<b><font color='white'> TABLE OF CONTENTS</font></b>", S("TH3", fontSize=11, fontName="Helvetica-Bold", leading=14))]] + toc_rows, colWidths=[2.5*cm, 14.5*cm]) toc_t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), NAVY), ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LGREY]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#cccccc")), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ("SPAN", (0,0), (-1,0)), ("VALIGN", (0,0), (-1,-1), "TOP"), ])) story.append(toc_t) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 1 – GENERAL SURGERY PRINCIPLES # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 1: GENERAL SURGERY PRINCIPLES", NAVY)) story.append(Spacer(1, 6)) # 1A Wounds story.append(Paragraph("A. WOUNDS & WOUND HEALING", SEC_HEAD)) story.extend(section_box("Types of Wounds", [ "Incised – clean cut by sharp instrument; heals well", "Lacerated – irregular tear; high infection risk", "Contused – blunt injury; crushed tissue", "Puncture – small entry, deep track; high anaerobic risk", "Gunshot – entry + exit; high velocity = massive tissue destruction", "Burn – thermal, chemical, electrical, radiation", ])) story.extend(section_box("Phases of Wound Healing", [ "Haemostasis (0–few hrs): Platelet plug, fibrin clot, vasoconstriction", "Inflammatory (1–4 days): Neutrophils → Macrophages; growth factors released", "Proliferative (4–21 days): Fibroblasts → collagen; angiogenesis; epithelialisation", "Remodelling (21 days – 2 yrs): Collagen crosslinking; scar matures; tensile strength ↑", ])) story.extend(section_box("Types of Healing", [ "Primary intention – wound edges approximated (sutured); minimal scar", "Secondary intention – wound left open; heals by granulation; more scar", "Tertiary (delayed primary) – wound cleaned, left open, closed after 4–5 days", ])) story.extend(section_box("Factors Affecting Wound Healing", [ "LOCAL: Infection, foreign body, poor blood supply, wound size/depth, tension", "SYSTEMIC: Malnutrition (Vit C, Zn deficiency), diabetes, steroids, immunosuppression, jaundice, uraemia", "Keloid – scar beyond wound margins; familial; Rx: intralesional steroids, pressure, excision + radiotherapy", "Hypertrophic scar – stays within wound margins; regresses with time", ])) story.extend(key_box("Tensile strength: 70% at 6 weeks, never returns to 100% of original tissue.")) story.append(Paragraph("B. ULCERS", SEC_HEAD)) story.extend(section_box("Ulcer – Definition & Classification", [ "Ulcer = break in continuity of epithelial surface", "ARTERIAL: Punched-out, painful, pale base; dorsum of foot; no pulse", "VENOUS: Sloping edges, medial malleolus, painless, lipodermatosclerosis", "NEUROPATHIC (Trophic): Painless, callous margins, plantar surface, pressure points", "MARJOLIN'S ULCER: Squamous cell carcinoma arising in chronic scar/ulcer", "TUBERCULAR: Undermined edges, pale granulation, 'wash-leather' slough", ])) story.extend(key_box("Marjolin's ulcer: malignant transformation in chronic scar (burns, osteomyelitis sinus). Behaviour: less aggressive than de novo SCC.")) story.append(Paragraph("C. SINUS & FISTULA", SEC_HEAD)) story.extend(section_box("Key Definitions", [ "Sinus – blind-ending tract lined by granulation tissue, opening on surface", "Fistula – abnormal communication between two epithelial surfaces", "Fistula types: Congenital / Acquired (traumatic, inflammatory, neoplastic, iatrogenic)", "HIGH OUTPUT fistula: >500 mL/day (small bowel); LOW OUTPUT: <200 mL/day", "Causes of failure to close: FRIENDS – Foreign body, Radiation, Infection/IBD, Epithelialised, Neoplasm, Distal obstruction, Steroids", ])) story.append(Paragraph("D. SHOCK", SEC_HEAD)) story.extend(section_box("Types of Shock", [ "Hypovolaemic – blood/fluid loss; MC type in surgery", "Cardiogenic – pump failure (MI, tamponade, tension pneumothorax)", "Distributive – Septic / Anaphylactic / Neurogenic", "Obstructive – massive PE, tension pneumothorax", ])) story.extend(section_box("Haemorrhagic Shock Classification (ATLS)", [ "Class I: <750 mL (<15%); HR<100; no change in BP; anxious", "Class II: 750–1500 mL (15–30%); HR 100–120; narrow pulse pressure; anxious", "Class III: 1500–2000 mL (30–40%); HR 120–140; BP ↓; confused", "Class IV: >2000 mL (>40%); HR>140; BP very low; confused/lethargic; life-threatening", ])) story.extend(key_box("Septic shock (Warm shock): warm peripheries, high CO, low SVR. Cold shock = late stage, high SVR.")) story.append(Paragraph("E. BURNS", SEC_HEAD)) story.extend(section_box("Burns Assessment", [ "Rule of Nines (Wallace): Head=9%, each arm=9%, chest=9%, abdomen=9%, each thigh=9%, each leg=9%, perineum=1%", "SUPERFICIAL (1st degree): Epidermis only; erythema, pain; heals in 5–7 days", "PARTIAL THICKNESS (2nd degree): Into dermis; blisters, painful; heals 2–3 weeks", "FULL THICKNESS (3rd degree): All layers; painless (nerve destruction); eschar; needs grafting", "Parkland Formula: 4 mL × kg × %TBSA burned (Ringer's lactate); half in first 8 hrs, rest over 16 hrs", ])) story.extend(section_box("Complications of Burns", [ "Early: Hypovolaemia, renal failure, Curling's ulcer (stress ulcer)", "Late: Wound infection (Pseudomonas commonest), contracture, Marjolin's ulcer", "Inhalation injury: Most common cause of death in burns", ])) story.extend(key_box("Curling's ulcer = stress ulcer in duodenum after severe burns. Prevent with H2 blockers/PPIs.")) story.append(Paragraph("F. ELECTROLYTES & NUTRITION", SEC_HEAD)) story.extend(section_box("Key Electrolyte Disturbances in Surgery", [ "Hyponatraemia: Serum Na <135; SIADH post-op; Rx: fluid restriction / hypertonic saline", "Hypokalaemia: K <3.5; ileus, alkalosis, arrhythmia; Rx: KCl infusion (max 40 mEq/hr)", "Hyperkalaemia: K >5.5; ECG changes (peaked T, wide QRS); Rx: Ca gluconate, insulin+dextrose", "Metabolic acidosis: HCO3 ↓, pH ↓; post-op shock, sepsis, AKI", "Metabolic alkalosis: HCO3 ↑; post-pyloric stenosis vomiting (lose HCl)", ])) story.extend(section_box("Nutrition in Surgery", [ "Enteral Nutrition (EN): Preferred route; maintains gut integrity; via NG tube or PEG", "Parenteral Nutrition (TPN): IV route; use when GI tract non-functional", "Indication for TPN: Short bowel syndrome, high-output fistula, prolonged ileus, GI obstruction", "Refeeding syndrome: Hypophosphataemia after restarting nutrition in starved patient", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 2 – NEOPLASMS & ONCOLOGY IN SURGERY # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 2: NEOPLASMS, SKIN TUMOURS & ONCOLOGY", TEAL)) story.append(Spacer(1, 6)) story.append(Paragraph("BENIGN vs MALIGNANT TUMOURS", SEC_HEAD)) story.extend(two_col_table("Feature", "Benign vs Malignant", [("Growth", "Slow / well-defined vs rapid / infiltrative"), ("Capsule", "Usually encapsulated vs no capsule"), ("Metastasis", "None vs regional + distant"), ("Mitoses", "Rare/normal vs frequent/atypical"), ("Recurrence", "Rare after excision vs common"), ("Effect", "Local pressure vs local invasion + cachexia"), ])) story.append(Paragraph("SKIN TUMOURS", SEC_HEAD)) story.extend(section_box("Common Skin Tumours", [ "Sebaceous cyst (Epidermoid cyst): Blocked sebaceous duct; punctum visible; Rx: excision", "Lipoma: Soft, lobulated, subcutaneous; painless; Rx: excision if symptomatic", "Dermoid cyst: Along lines of embryonic fusion; doughy feel; Rx: excision", "Basal Cell Carcinoma (BCC): Most common skin cancer; rodent ulcer; rolled pearly edges; sun-exposed areas; rarely metastasises", "Squamous Cell Carcinoma (SCC): Second commonest; everted edges; metastasises to lymph nodes", "Malignant Melanoma: Most dangerous; ABCDE criteria; Breslow thickness determines prognosis", "Keratoacanthoma: Rapid growth; spontaneous regression; resembles SCC – excise", ])) story.extend(key_box("Breslow thickness: <1 mm = good prognosis; >4 mm = poor prognosis for melanoma.")) story.append(Paragraph("SARCOMAS", SEC_HEAD)) story.extend(section_box("Soft Tissue Sarcomas", [ "Arise from mesenchymal tissue (fat, muscle, fascia, bone, vessels)", "Types: Liposarcoma, Rhabdomyosarcoma, Leiomyosarcoma, Synovial sarcoma", "Mx: Wide local excision (WLE) + adjuvant radiotherapy; chemo for metastatic", "Retroperitoneal sarcoma: Diagnosed late; large mass; surgery is mainstay", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 3 – NECK & THYROID # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 3: NECK, THYROID & PARATHYROID", colors.HexColor("#1b4332"))) story.append(Spacer(1, 6)) story.append(Paragraph("NECK SWELLINGS – APPROACH", SEC_HEAD)) story.extend(section_box("Anatomical Triangles & Common Swellings", [ "Anterior triangle: Thyroid swelling, lymph nodes, thyroglossal cyst, branchial cyst", "Posterior triangle: Lymph nodes (MC), cervical rib, subclavian artery aneurysm", "Thyroglossal cyst: Midline; moves up with tongue protrusion; Rx: Sistrunk operation", "Branchial cyst: Lateral; 2nd arch; anterior to sternomastoid; lined by stratified squamous; Rx: excision", "Cystic hygroma: Lymphatic malformation; transilluminates brilliantly; present at birth; posterior triangle", "Carotid body tumour: At carotid bifurcation; transmitted pulsation; 'potato tumour'; Rx: surgical excision", ])) story.append(Paragraph("THYROID GLAND", SEC_HEAD)) story.extend(section_box("Thyroid Swelling – Key Points", [ "Moves with deglutition (attached to pretracheal fascia)", "Goitre = enlarged thyroid; Physiological / Pathological", "SIMPLE GOITRE: Iodine deficiency; Rx: iodine supplementation, thyroxine, surgery for compression", "TOXIC GOITRE (Hyperthyroidism): Graves' disease (commonest), toxic MNG, toxic adenoma", "Graves' disease: Autoimmune; TSI antibodies; Rx: carbimazole/PTU, radioiodine, thyroidectomy", ])) story.extend(section_box("Thyroid Cancers", [ "Papillary (MC – 60–70%): Best prognosis; PTC cells with 'ground glass' nuclei; Rx: thyroidectomy + RAI", "Follicular (20%): Haematogenous spread; vascular invasion; Rx: thyroidectomy", "Medullary (5%): Parafollicular C cells; secretes calcitonin; associated with MEN 2A/2B", "Anaplastic: Most aggressive; rapidly fatal; Rx: palliative", "Lymphoma: Associated with Hashimoto's thyroiditis", ])) story.extend(section_box("Thyroidectomy – Complications", [ "Haemorrhage: Immediate; haematoma → airway compression → emergency re-exploration", "RLN injury: Unilateral – hoarseness; Bilateral – stridor, emergency tracheostomy", "Hypoparathyroidism: Hypocalcaemia; tingling, tetany, Chvostek's/Trousseau's sign", "Thyroid storm: Hyperthermia, tachycardia, AF; Rx: propranolol, lugol's iodine, PTU, dexamethasone", "Wound infection, scar keloid", ])) story.extend(key_box("NEVER forget: Check vocal cords pre/post thyroidectomy. Keep 10 mL 10% calcium gluconate at bedside post-op.")) story.append(Paragraph("PARATHYROID", SEC_HEAD)) story.extend(section_box("Hyperparathyroidism", [ "Primary: Adenoma (80%), hyperplasia (15%), carcinoma (5%); High Ca, Low PO4, High PTH", "Symptoms: 'Bones, Stones, Groans, Psychic moans' – bone pain, renal stones, abdo pain, depression", "Investigations: Sestamibi scan; USG neck", "Rx: Parathyroidectomy (adenoma excision)", "Secondary: Response to low Ca in CKD; Low Ca, High PTH; Rx: treat underlying CKD", "Tertiary: Autonomous PTH secretion after renal transplant; High Ca + High PTH", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 4 – BREAST # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 4: BREAST SURGERY", colors.HexColor("#6d2b7a"))) story.append(Spacer(1, 6)) story.extend(section_box("Benign Breast Conditions", [ "Fibroadenoma: MC in young women; 'breast mouse'; firm, mobile, rubbery; Rx: excision biopsy", "Fibrocystic disease (ANDI): Most common benign; cyclical pain; Rx: reassurance, evening primrose oil", "Breast abscess: Lactational (S. aureus) vs Periareolar (non-lactational); Rx: antibiotics + aspiration/incision", "Duct ectasia: Dilated ducts; thick nipple discharge; periductal mastitis", "Duct papilloma: Bloody nipple discharge; solitary intraductal papilloma; Rx: microdochectomy", "Phyllodes tumour: Large, fast-growing; Rx: wide local excision", ])) story.extend(section_box("Breast Cancer", [ "Epidemiology: MC cancer in women; risk factors – BRCA1/2, family history, nulliparity, early menarche, late menopause, OCP", "Types: IDC (MC, 70%), ILC, DCIS, LCIS, Paget's disease of nipple, Inflammatory carcinoma", "CLINICAL FEATURES: Hard lump, skin dimpling, nipple retraction, peau d'orange, axillary nodes", "Paget's disease: Eczematous nipple change; underlying DCIS/IDC; Paget cells on biopsy", "Inflammatory carcinoma: Skin oedema, erythema; dermal lymphatic invasion; worst prognosis", ])) story.extend(section_box("Breast Cancer – Investigations", [ "Triple Assessment: Clinical exam + Imaging (USG/mammogram) + Biopsy (FNAC/core)", "Mammography: Best screening tool for women >40 yrs; BIRADS 1–6 classification", "USG breast: Preferred in women <35 yrs; distinguishes cyst from solid", "Core needle biopsy: Gold standard tissue diagnosis", "Staging: CT chest/abdomen/pelvis, bone scan, PET scan", ])) story.extend(section_box("Breast Cancer – Management", [ "SURGICAL: BCS (lumpectomy + sentinel node/axillary clearance) OR Modified Radical Mastectomy (MRM)", "SENTINEL NODE BIOPSY: First node draining breast; blue dye + radioisotope; avoids routine ALND", "RADIOTHERAPY: After BCS always; after MRM if high risk", "CHEMOTHERAPY: Anthracycline-based (AC); taxanes; neoadjuvant for large/locally advanced", "HORMONE THERAPY: ER/PR positive – Tamoxifen (premenopausal); Aromatase inhibitors (postmenopausal)", "TARGETED: HER2+ – Trastuzumab (Herceptin)", "TNM STAGING: T1 <2cm, T2 2–5cm, T3 >5cm, T4 any size with skin/chest wall; N0–N3; M0/M1", ])) story.extend(key_box("BRCA1/2 mutation carriers: Lifetime breast Ca risk 70–85%. Prophylactic mastectomy reduces risk by 95%.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 5 – OESOPHAGUS & STOMACH # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 5: OESOPHAGUS & STOMACH", TEAL)) story.append(Spacer(1, 6)) story.extend(section_box("Oesophageal Conditions", [ "GERD: Acid reflux; heartburn; Rx: PPI, lifestyle; surgery: Nissen fundoplication", "Barrett's oesophagus: Metaplasia of squamous to columnar epithelium; premalignant; surveillance endoscopy", "Achalasia: Failure of LOS relaxation; absent peristalsis; bird-beak on barium; Rx: Heller's cardiomyotomy / pneumatic dilatation", "Pharyngeal pouch (Zenker's): At Killian's dehiscence; dysphagia, regurgitation, aspiration; Rx: endoscopic or open cricopharyngeal myotomy", "Plummer-Vinson syndrome: Iron deficiency anaemia + postcricoid web + dysphagia; premalignant", ])) story.extend(section_box("Oesophageal Cancer", [ "SCC: Upper 2/3; associated with smoking, alcohol, achalasia, Plummer-Vinson", "Adenocarcinoma: Lower 1/3; associated with GERD, Barrett's; increasing incidence", "Presentation: Progressive dysphagia (solids → liquids), weight loss, regurgitation", "Ix: Barium swallow (rat-tail narrowing), OGD + biopsy, CT staging", "Rx: Ivor-Lewis oesophagectomy; McKeown 3-stage; chemoradiotherapy for unresectable", "Prognosis: 5-year survival ~20% overall; best if caught early", ])) story.append(Paragraph("STOMACH", SEC_HEAD)) story.extend(section_box("Peptic Ulcer Disease", [ "Duodenal ulcer (DU): More common; H. pylori in 95%; acid hypersecretion; pain relieved by food", "Gastric ulcer (GU): H. pylori in 70%; pain worsened by food; ALWAYS biopsy to exclude malignancy", "Investigations: OGD (gold standard), CLO test/urea breath test for H. pylori", "Medical Rx: Triple therapy – PPI + Clarithromycin + Amoxicillin × 14 days", "Complications: Haemorrhage, perforation, obstruction, malignancy (GU only)", "Perforated DU: Sudden severe pain, board-like rigidity, free air under diaphragm; Rx: Graham's patch repair", ])) story.extend(section_box("Gastric Cancer", [ "Risk factors: H. pylori, diet (smoked/salted), blood group A, atrophic gastritis", "Virchow's node: Left supraclavicular node – metastasis from gastric/GI cancer", "Sister Mary Joseph nodule: Umbilical metastasis", "Krukenberg tumour: Ovarian metastasis; signet ring cells", "Rx: Gastrectomy (total/subtotal) + D2 lymphadenectomy; adjuvant chemo", "Staging: CT abdomen, diagnostic laparoscopy before major resection", ])) story.extend(key_box("Cushing's ulcer = stress ulcer after head injury (increased vagal activity). Curling's ulcer = after burns.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 6 – SMALL BOWEL & APPENDIX # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 6: SMALL INTESTINE, APPENDIX & PERITONITIS", GREEN)) story.append(Spacer(1, 6)) story.extend(section_box("Small Intestine Conditions", [ "Intestinal Obstruction: MC = adhesions (post-op); then hernia", "Features: Colicky pain, vomiting, distension, absolute constipation", "Simple vs Strangulated: Strangulation = vascular compromise; tender, fever, peritonism", "Investigation: AXR – distended loops, air-fluid levels; CT abdomen for diagnosis", "Rx: NG suction, IV fluids, then surgery if not resolving", "Crohn's disease: Skip lesions; transmural; any part of GI; cobblestone mucosa; string sign of Kantor on barium", "Meckel's diverticulum: True diverticulum; ileum 2 feet from ileocaecal valve; 2% population; may contain ectopic gastric mucosa → bleeding", ])) story.extend(section_box("APPENDIX", [ "Acute appendicitis: MC surgical emergency in young; obstructed lumen → infection", "Alvarado score: Migratory RIF pain (1), anorexia (1), nausea (1), RIF tenderness (2), rebound (1), elevated temp (1), leukocytosis (2) – Max 10", "Score ≥7: Appendicitis likely; Score <4: Unlikely", "McBurney's point: 2/3rd from umbilicus to ASIS; maximum tenderness", "Rovsing's sign: Pressure on LIF → pain in RIF", "Psoas sign: Extend right hip → pain (retrocaecal appendix)", "Rx: Appendicectomy (open McBurney's incision or laparoscopic)", "Appendix mass: Managed conservatively (Ochsner-Sherren regimen) → interval appendicectomy at 3 months", "Carcinoid of appendix: MC tumour of appendix; tip of appendix; Rx: appendicectomy if <2cm", ])) story.extend(key_box("Alvarado score: 5–6 = equivocal (CT scan), 7–10 = high probability → operate.")) story.extend(section_box("PERITONITIS", [ "Primary: Spontaneous bacterial peritonitis (SBP) – in cirrhosis/ascites; E. coli", "Secondary: Perforated viscus, gangrenous bowel, appendicitis; Rx: emergency surgery", "Features: Board-like rigidity, guarding, absent bowel sounds, Cullen's/Grey Turner's sign (in pancreatitis)", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 7 – LARGE BOWEL, RECTUM & ANUS # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 7: COLON, RECTUM & ANUS", colors.HexColor("#7b2d00"))) story.append(Spacer(1, 6)) story.extend(section_box("Colorectal Cancer", [ "Epidemiology: 3rd commonest cancer; diet (red meat, low fibre), IBD, FAP, HNPCC (Lynch syndrome)", "Adenoma-carcinoma sequence: Most arise from adenomatous polyps", "Duke's Classification: A=submucosa, B=muscle, C=lymph nodes, D=distant metastasis", "MODIFIED DUKE'S (Astler-Coller): More detailed classification now replaced by TNM", "Presentation: Right colon – anaemia, mass; Left colon – change in bowel habit, obstruction; Rectum – PR bleeding, tenesmus", "Ix: Colonoscopy + biopsy (gold standard); CEA as tumour marker; CT colonography", "Rx: Right hemicolectomy (R colon); Sigmoid colectomy; Anterior resection (upper rectum); APR = abdominoperineal resection (lower rectum)", ])) story.extend(section_box("IBD – Crohn's vs Ulcerative Colitis", [ "Crohn's: Any GI tract; transmural; skip lesions; cobblestone; fistulae; granulomas; perianal disease", "UC: Colon only (backwash ileitis); mucosal only; continuous; pseudopolyps; risk of CRC", "EXTRAINTESTINAL: Pyoderma gangrenosum, erythema nodosum, uveitis, primary sclerosing cholangitis (UC)", "Rx Crohn's: Steroids, azathioprine, biologics (infliximab), surgery for complications", "Rx UC: Aminosalicylates (5-ASA), steroids, immunomodulators; panproctocolectomy (curative)", ])) story.extend(section_box("ANORECTAL CONDITIONS", [ "Haemorrhoids (Piles): Dilated internal rectal venous plexus; commonest cause PR bleeding in adults", ">> Grades: I=bleed only, II=prolapse+reduce, III=need manual reduction, IV=irreducible", ">> Rx: Dietary (fibre), rubber band ligation, injection sclerotherapy, haemorrhoidectomy (Milligan-Morgan)", "Anal Fissure: Tear in anoderm; commonest in posterior midline; severe pain after defaecation; Rx: GTN/diltiazem cream, lateral internal sphincterotomy", "Anorectal Abscess: Perianal (MC), ischiorectal, intersphincteric, suprasphincteric", "Fistula-in-ano: Goodsall's rule – posterior fistulae curve, anterior fistulae straight; Park's classification", "Pilonidal sinus: Natal cleft; young hairy men; Rx: excision and healing by secondary intention", ])) story.extend(key_box("Parks' classification of fistula-in-ano: Intersphincteric (MC), Trans-sphincteric, Suprasphincteric, Extrasphincteric.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 8 – LIVER, BILIARY SYSTEM & PANCREAS # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 8: LIVER, BILIARY SYSTEM & PANCREAS", colors.HexColor("#344e41"))) story.append(Spacer(1, 6)) story.extend(section_box("Liver – Key Conditions", [ "Hepatocellular carcinoma (HCC): MC primary liver tumour; AFP raised; cirrhosis background; Rx: resection, ablation, transplant", "Amoebic liver abscess: RUQ pain, fever; single; right lobe; 'anchovy sauce' pus; Rx: metronidazole + aspiration", "Pyogenic liver abscess: Multiple; E. coli; from portal pyaemia; Rx: IV antibiotics + percutaneous drainage", "Hydatid cyst: Echinococcus granulosus; 'daughter cysts'; 'egg-shell calcification'; Rx: PAIR or surgery", "Portal hypertension: Pre-hepatic (portal vein thrombosis), Hepatic (cirrhosis), Post-hepatic (Budd-Chiari)", "Oesophageal varices: Rx: acute – terlipressin + endoscopic band ligation; prevention – propranolol + banding", ])) story.extend(section_box("GALLBLADDER & BILE DUCTS", [ "Gallstones: Cholesterol (MC in West), Pigment (haemolysis), Mixed", "Acute cholecystitis: RUQ pain + fever + Murphy's sign; Rx: IV antibiotics + laparoscopic cholecystectomy", "Mucocele: Distended GB with mucus; obstructed cystic duct; painless mass", "Empyema: Pus in GB; toxic patient; emergency drainage", "Mirizzi syndrome: Gallstone in Hartmann's pouch → external compression of CBD", "Choledocholithiasis: CBD stones; obstructive jaundice + Charcot's triad (fever, jaundice, RUQ pain)", "Reynold's pentad: Charcot's triad + confusion + hypotension = acute suppurative cholangitis", "ERCP: For CBD stones; sphincterotomy + stone extraction", "Carcinoma GB: MC = adenocarcinoma; porcelain GB; poor prognosis; Rx: extended cholecystectomy", "Courvoisier's law: Palpable, painless GB in presence of jaundice = NOT gallstones = carcinoma (head of pancreas)", ])) story.extend(section_box("PANCREAS", [ "Acute pancreatitis: MC causes – gallstones + alcohol (GET SMASHED mnemonic)", "Ranson's criteria: >3 = severe; 11 parameters (5 at admission, 6 at 48hrs)", "CT severity index (Balthazar): Grade A–E; necrosis percentage", "Complications: Pseudocyst, abscess, ARDS, renal failure, DIC", "Chronic pancreatitis: Alcohol (MC); epigastric pain radiating to back; 'chain of lakes' on ERCP; steatorrhoea; DM", "Pancreatic cancer: Head (75%, obstructive jaundice), Body/tail (back pain, weight loss)", "Whipple's procedure: Pancreaticoduodenectomy for carcinoma head pancreas", "Insulinoma: Whipple's triad – hypoglycaemia, symptoms, relief with glucose", "Glucagonoma: Necrolytic migratory erythema, diabetes, anaemia", ])) story.extend(key_box("ERCP is BOTH diagnostic and therapeutic for CBD stones, strictures, and biliary leaks.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 9 – HERNIAS # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 9: HERNIAS & ABDOMINAL WALL", colors.HexColor("#023e8a"))) story.append(Spacer(1, 6)) story.extend(section_box("General Hernia Principles", [ "Hernia = protrusion of viscus through its containing wall", "Parts: Sac (peritoneum), Contents (bowel/omentum), Coverings", "Types: Reducible, Irreducible, Obstructed, Strangulated", "Strangulated hernia = surgical emergency (vascular compromise → ischaemia → necrosis)", ])) story.extend(section_box("Inguinal Hernia", [ "INDIRECT: Through deep inguinal ring; congenital; MC type; young males", "DIRECT: Through Hesselbach's triangle; acquired; weakness in transversalis fascia; elderly", "Hesselbach's triangle: Inguinal ligament (inferior), inferior epigastric vessels (lateral), rectus sheath (medial)", "Zieman's test/Deep ring occlusion test: Distinguishes direct vs indirect", "Rx: Open – Bassini / Shouldice / Lichtenstein mesh repair (tension-free); Laparoscopic – TEP/TAPP", ])) story.extend(section_box("Femoral Hernia", [ "Below and lateral to pubic tubercle; MC in women but inguinal still MC overall", "High risk of strangulation (narrow neck of femoral canal)", "Rx: Lockwood (low), Lothiessen (transinguinal), McEvedy (high) approach", "RICHTER's hernia: Only part of circumference of bowel in sac – can strangulate without obstruction", "MAYDL's hernia (hernia-en-W): Two loops of bowel in sac; middle loop can strangulate inside abdomen", ])) story.extend(section_box("Special Hernias", [ "Umbilical hernia: In infants – usually resolves by 5 years; adults – acquired; Rx: Mayo repair", "Epigastric hernia: Through linea alba; small; usually fatty tissue", "Spigelian hernia: Defect in spigelian fascia; lateral edge of rectus; can be occult", "Obturator hernia: Through obturator foramen; elderly thin women; Howship-Romberg sign (inner thigh pain on hip extension)", "Incisional hernia: Post-surgical; Rx: mesh repair", "Parastomal hernia: Adjacent to stoma; Rx: stoma relocation + mesh", ])) story.extend(key_box("Littre's hernia = Meckel's diverticulum in the sac. Strangulation is MOST dangerous in femoral hernia.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 10 – VASCULAR SURGERY # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 10: VASCULAR SURGERY", colors.HexColor("#c1121f"))) story.append(Spacer(1, 6)) story.extend(section_box("Peripheral Arterial Disease (PAD)", [ "Fontaine classification: I=asymptomatic, II=claudication, III=rest pain, IV=ulceration/gangrene", "ABPI: Normal 0.9–1.3; Claudication 0.5–0.9; Rest pain <0.5; Critical ischaemia <0.3", "ABI = Ankle Brachial Pressure Index", "Critical limb ischaemia: Rest pain >2 weeks OR tissue loss (ulcer/gangrene)", "Buerger's disease (TAO): Young male smokers; tibial/radial arteries; migratory thrombophlebitis; Rx: STOP SMOKING", "Ix: Duplex USG, CT angiography, MR angiography", "Rx: Medical (antiplatelets, statins, exercise); Endovascular (angioplasty/stent); Surgical (bypass graft)", ])) story.extend(section_box("Acute Limb Ischaemia – 6 Ps", [ "Pain, Pallor, Paraesthesia, Pulselessness, Paralysis, Perishingly cold", "Causes: Embolism (commonest – AF, recent MI) vs Thrombosis (on existing atherosclerosis)", "Embolism: Sudden; normal contralateral leg; AF; Rx: embolectomy (Fogarty catheter)", "Thrombosis: History of claudication; Rx: thrombolysis or bypass", "Window for embolectomy: <6 hours (before irreversible muscle damage)", ])) story.extend(section_box("Aortic Aneurysm", [ "AAA (Abdominal Aortic Aneurysm): >3cm = aneurysm; >5.5cm = operate", "Risk: Rupture increases dramatically at >5.5cm (annual risk >10%)", "Ruptured AAA: Triad – hypotension, back/abdo pain, pulsatile mass; 80% pre-hospital mortality", "Rx: EVAR (endovascular) preferred if anatomy suitable; Open repair otherwise", "Thoracic aneurysm: Marfan's, dissection; CXR shows widened mediastinum", "Aortic dissection: Stanford A (ascending) = surgical emergency; Stanford B (descending) = medical", ])) story.extend(section_box("VENOUS DISEASES", [ "Varicose veins: Dilated tortuous superficial veins; SFJ incompetence (MC); Trendelenburg test", "DVT: Calf pain, swelling, warmth; Wells score; confirm with Duplex USG", "Homans' sign: Calf pain on dorsiflexion – unreliable test", "DVT Rx: LMWH → Warfarin/DOAC (3–6 months); IVC filter if anticoagulation CI", "PE: Pleuritic chest pain, SOB, haemoptysis; CTPA = gold standard; Rx: anticoagulation, thrombolysis for massive PE", "Chronic venous insufficiency: Lipodermatosclerosis, venous ulcers (medial malleolus)", ])) story.extend(key_box("DVT prophylaxis post-surgery: TED stockings + LMWH + early mobilisation. High risk: THR, THJ, major abdominal surgery.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 11 – UROLOGY # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 11: UROLOGY – KIDNEY, URETER, BLADDER, PROSTATE", TEAL)) story.append(Spacer(1, 6)) story.extend(section_box("Kidney – Key Conditions", [ "Renal cell carcinoma (RCC): 'Haematuria, flank pain, lump' – classic triad (only 10% have all 3)", "Clear cell type (MC); associated with VHL syndrome", "Rx: Radical nephrectomy; partial for small tumours; sunitinib for metastatic", "Wilms' tumour (Nephroblastoma): MC renal tumour in children (<5 yrs); Rx: nephrectomy + chemo/radio", "Renal calculi: Commonest = calcium oxalate; uric acid stones are radiolucent", "Staghorn calculus: Struvite (infection stones); fill pelvis + calyces; Rx: PCNL", "ESWL: For stones <2cm; contraindicated in pregnancy, aortic aneurysm, coagulopathy", "PCNL: For stones >2cm or staghorn", ])) story.extend(section_box("Bladder & Ureteric Conditions", [ "Transitional cell carcinoma (TCC) of bladder: MC bladder cancer; painless haematuria", "Risk factors: Smoking, aniline dyes (industrial), cyclophosphamide, schistosomiasis (SCC)", "Rx: TURBT for superficial; radical cystectomy + ileal conduit for muscle-invasive", "BPH: Age-related enlargement; median lobe; LUTS (urgency, frequency, nocturia, poor stream)", "PSA: Prostate specific antigen; raised in BPH, prostatitis, Ca prostate", "Rx BPH: Alpha blockers (tamsulosin), 5-alpha reductase inhibitors (finasteride), TURP (gold standard surgical)", ])) story.extend(section_box("Prostate Cancer", [ "Commonest cancer in elderly men; peripheral zone; adenocarcinoma; Gleason score", "Spread: Bone metastases (osteosclerotic/blastic); raised ALP, PSA", "Rx: Localised – radical prostatectomy / radiotherapy / active surveillance", "Advanced – ADT (LHRH agonists/antagonists), enzalutamide, docetaxel", "Scrotal conditions: Epididymo-orchitis (bacterial); torsion (surgical emergency 4–6hr window); hydrocele; varicocele (left); seminoma / teratoma", ])) story.extend(key_box("Testicular torsion = 'bell clapper deformity'; blue/black discolouration; Rx: emergency surgery within 6 hrs to preserve testis.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 12 – TRAUMA & ORTHOPAEDIC SURGERY # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 12: TRAUMA, FRACTURES & ORTHOPAEDICS", colors.HexColor("#495057"))) story.append(Spacer(1, 6)) story.extend(section_box("ATLS Primary Survey – ABCDE", [ "A – Airway with cervical spine control", "B – Breathing and ventilation", "C – Circulation with haemorrhage control", "D – Disability (neurological status, GCS)", "E – Exposure and environment (undress patient, prevent hypothermia)", "SECONDARY SURVEY: Head-to-toe examination after resuscitation", ])) story.extend(section_box("Head Injury", [ "Primary injury: At time of impact (contusion, laceration, diffuse axonal injury)", "Secondary injury: Due to hypoxia, hypotension, raised ICP", "Extradural haematoma (EDH): Arterial (middle meningeal); lucid interval; biconvex on CT; Rx: emergency burr hole", "Subdural haematoma (SDH): Venous; crescent-shaped; no lucid interval; elderly/alcoholics", "FOUR Stages of intracranial hypertension: Cushing's response = hypertension + bradycardia + irregular breathing (late sign, pre-herniation)", "GCS: E4V5M6 = 15 (normal); <8 = coma; <9 = intubate", "Mx raised ICP: Head elevation 30°, mannitol, hyperventilation, neurosurgery", ])) story.extend(section_box("Chest Trauma", [ "Tension pneumothorax: Tracheal deviation away; absent breath sounds; shocked; Rx: needle decompression (2nd ICS MCL) then chest drain", "Open pneumothorax: 'Sucking wound'; Rx: 3-sided occlusive dressing then chest drain", "Massive haemothorax: >1500mL blood; Rx: chest drain; consider thoracotomy if >200mL/hr", "Flail chest: ≥3 consecutive ribs broken in 2 places; paradoxical movement; Rx: positive pressure ventilation", "Cardiac tamponade: Beck's triad – muffled heart sounds, raised JVP, hypotension; Rx: pericardiocentesis", ])) story.extend(section_box("Abdominal Trauma", [ "FAST scan: Focused Assessment with Sonography for Trauma; looks for free fluid", "DPL (Diagnostic peritoneal lavage): >100,000 RBCs = positive; largely replaced by CT", "Splenic injury: MC solid organ injured; Grades I–V; haemodynamically stable → splenic salvage; unstable → splenectomy", "Liver laceration: Grade I–VI; angioembolisation for stable; surgery for unstable", "Damage control surgery: Abbreviated initial operation → ICU stabilisation → definitive surgery", ])) story.extend(key_box("Tension pneumothorax: DO NOT wait for CXR – clinical diagnosis → immediate needle decompression.")) story.extend(section_box("FRACTURES – Key Concepts", [ "Closed (simple) vs Open (compound) – break in skin over fracture", "Gustilo classification of open fractures: I (<1cm clean), II (1–10cm), IIIA (adequate cover), IIIB (periosteal stripping), IIIC (vascular injury)", "Compartment syndrome: Pain out of proportion, pain on passive stretch, paraesthesia; Rx: fasciotomy", "Fat embolism: After long bone fractures; 24–72hrs; triad – hypoxia, petechiae, confusion", "Colles' fracture: FOOSH; distal radius; dinner fork deformity; Rx: MUA + plaster", "Scaphoid fracture: Fall on outstretched hand; anatomical snuffbox tenderness; high AVN risk", "NOF fracture: Elderly osteoporotic; intracapsular (AVN risk) vs extracapsular; Rx: hemiarthroplasty/THR", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 13 – TRANSPLANTATION & SPLEEN # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 13: TRANSPLANTATION, SPLEEN & LYMPHATICS", GREEN)) story.append(Spacer(1, 6)) story.extend(section_box("Transplantation", [ "AUTOGRAFT: From self; no rejection", "ALLOGRAFT: From another human (most transplants); rejection possible", "XENOGRAFT: From another species; experimental", "Brain death criteria: Fixed dilated pupils, absent brainstem reflexes, no spontaneous respiration (apnoea test)", "Rejection types: Hyperacute (minutes; preformed Ab), Acute (days-weeks; T-cell mediated), Chronic (months-years; Ab/T-cell)", "Immunosuppression: Calcineurin inhibitors (tacrolimus, cyclosporin), mycophenolate mofetil, steroids, mTOR inhibitors (sirolimus)", "Kidney transplant: MC solid organ; heterotopic (iliac fossa); Rx of rejection: pulse steroids", "Liver transplant: Orthotopic; for end-stage liver disease; Child-Pugh/MELD score for prioritisation", ])) story.extend(section_box("SPLEEN", [ "Functions: Filtration (removes old/abnormal RBCs), Immune (IgM, opsonins), Haematopoiesis in foetal life", "Splenomegaly causes: Infections (malaria, EBV), haematological (CML, lymphoma, haemolytic anaemia), portal hypertension", "Hypersplenism: Splenomegaly + pancytopenia + hyperplastic marrow; Rx: splenectomy", "Post-splenectomy: Overwhelming post-splenectomy infection (OPSI) – capsulated organisms (S. pneumoniae, H. influenzae, N. meningitidis)", "Post-splenectomy vaccination: Pneumococcal, Hib, Meningococcal + lifelong penicillin V prophylaxis", "Howell-Jolly bodies: Post-splenectomy finding on blood film (nuclear remnants in RBCs)", ])) story.extend(section_box("LYMPHATICS & LYMPHOEDEMA", [ "Primary lymphoedema: Milroy's disease (congenital), Meige disease (puberty); pitting then non-pitting", "Secondary lymphoedema: MC worldwide = Filariasis (Wuchereria bancrofti); also post-surgery/radiotherapy", "Lymphoma: Hodgkin's (Reed-Sternberg cells; bimodal age) vs Non-Hodgkin's", "Hodgkin's: Contiguous spread; B symptoms; Rx: ABVD chemotherapy + radiotherapy", "Non-Hodgkin's: Non-contiguous; more extranodal; CHOP chemotherapy", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 14 – NEUROSURGERY & ENDOCRINE # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 14: NEUROSURGERY & ENDOCRINE SURGERY", NAVY)) story.append(Spacer(1, 6)) story.extend(section_box("NEUROSURGERY", [ "Brain tumours: Glioma (MC primary), Meningioma (extra-axial, benign), Acoustic neuroma (VIII nerve), Pituitary adenoma", "Glioblastoma (GBM): Most aggressive; Grade IV; butterfly lesion on MRI; Rx: surgery + temozolomide + RT", "Prolactinoma: MC pituitary tumour; galactorrhoea, amenorrhoea; Rx: dopamine agonist (cabergoline)", "Acromegaly: Growth hormone excess; large hands/feet; Rx: transsphenoidal surgery", "Cushing's disease: ACTH-secreting pituitary adenoma; Rx: transsphenoidal surgery", "Hydrocephalus: Obstructive vs Communicating; Rx: VP shunt or ETV (endoscopic 3rd ventriculostomy)", "Spinal cord compression: Emergency; loss of motor + sensory below level; bowel/bladder involvement; Rx: urgent decompression", ])) story.extend(section_box("ENDOCRINE SURGERY", [ "MEN 1: PPP – Pituitary + Parathyroid + Pancreatic islet tumours", "MEN 2A: Medullary thyroid Ca + Phaeochromocytoma + Hyperparathyroidism", "MEN 2B: Medullary thyroid Ca + Phaeochromocytoma + Mucosal neuromas (no hyperparathyroidism)", "Phaeochromocytoma: 10% rule – 10% bilateral, 10% malignant, 10% extra-adrenal; paroxysmal HT; Rx: phenoxybenzamine before surgery", "Conn's syndrome (Primary hyperaldosteronism): Hypertension + Hypokalaemia + Low renin; MC = adrenal adenoma; Rx: adrenalectomy", "Cushing's syndrome: Weight gain, striae, buffalo hump, moon face; 24hr UFC test; dexamethasone suppression test", "Carcinoid tumour: Serotonin-secreting; appendix (MC site); carcinoid syndrome only with liver mets (flushing, diarrhoea, wheezing)", ])) story.extend(key_box("Pre-op rule for phaeochromocytoma: alpha-blockade (phenoxybenzamine) FIRST, then beta-blockade. Never give beta-blockers first – causes hypertensive crisis.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 15 – PREOPERATIVE & POSTOPERATIVE CARE # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 15: PRE-OPERATIVE & POST-OPERATIVE CARE", colors.HexColor("#264653"))) story.append(Spacer(1, 6)) story.extend(section_box("Pre-Operative Assessment", [ "History: Previous surgery/anaesthesia, medications, allergies, comorbidities, smoking/alcohol", "ASA classification: I (healthy), II (mild systemic disease), III (severe), IV (incapacitating), V (moribund), VI (brain dead)", "Investigations: FBC, U&E, LFTs, coagulation, group & save; ECG (>40 yrs); CXR; echo if cardiac disease", "Fasting: 6 hours for solids; 2 hours for clear fluids (2-6 rule)", "DVT prophylaxis: Risk-stratify; low MW heparin + TED stockings; stop warfarin pre-op", "MRSA screening: Nasal swab; decolonise if positive", "Consent: Informed, voluntary, with capacity; include risks, benefits, alternatives", ])) story.extend(section_box("Intraoperative Care", [ "WHO Surgical Safety Checklist: Sign-in (before anaesthesia), Time-out (before incision), Sign-out (before leaving theatre)", "Anaesthesia types: GA, regional (spinal/epidural), local", "Blood transfusion: Trigger Hb <7 g/dL (general); <8 g/dL (cardiac); 1 unit raises Hb ~1 g/dL", "Surgical scrubbing: 3-min scrub; sterile field; aseptic technique", ])) story.extend(section_box("Post-Operative Complications", [ "Immediate (0–24hrs): Haemorrhage, airway obstruction, arrhythmia", "Early (1–7 days): Wound infection, UTI, chest infection, DVT, ileus", "Late (weeks-months): Wound dehiscence, incisional hernia, adhesions, anastomotic leak", "Anastomotic leak: Fever, tachycardia, peritonism; 5th–7th day; Rx: urgent re-exploration", "Wound dehiscence: Burst abdomen; pink fluid from wound; Rx: immediate suture", "SIRS/Sepsis: SIRS criteria: Temp >38°C or <36°C, HR >90, RR >20, WBC >12 or <4", "Sepsis-3 definition: Life-threatening organ dysfunction caused by dysregulated host response to infection", "Paralytic ileus: Absent bowel sounds; distension; NGT decompression; IV fluids", ])) story.extend(key_box("Sepsis 6 bundle (within 1 hr): Bloods/cultures, IV antibiotics, IV fluids, urinary catheter (monitor output), O2, lactate.")) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # CHAPTER 16 – SURGICAL INFECTIONS & ANTISEPTICS # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("CHAPTER 16: SURGICAL INFECTIONS, STERILISATION & ANTISEPTICS", TEAL)) story.append(Spacer(1, 6)) story.extend(section_box("Surgical Site Infection (SSI)", [ "Classification: Superficial incisional, Deep incisional, Organ/space", "MC organisms: S. aureus (skin), E. coli (GI), Pseudomonas (burns)", "Risk factors: Obesity, diabetes, malnutrition, immunosuppression, prolonged surgery", "Antibiotic prophylaxis: Given within 60 min of incision; cefazolin for most; metronidazole added for GI/colonic", ])) story.extend(section_box("Specific Infections", [ "Gas gangrene: Clostridium perfringens; crepitus in wound; bronze/blue discolouration; Rx: emergency surgery + penicillin + hyperbaric O2", "Tetanus: C. tetani; toxin → spastic paralysis; risus sardonicus, lockjaw, opisthotonus; Rx: TIG, penicillin, diazepam", "Necrotising fasciitis: Rapid-spreading infection of fascial planes; Type I (mixed) vs Type II (group A Strep); LRINEC score; Rx: URGENT surgical debridement", "Actinomycosis: Actinomyces israelii; cervicofacial (MC), thoracic, abdominal; sulphur granules; Rx: penicillin", "Tuberculosis in surgery: TB lymphadenitis (MC extrapulmonary); cold abscess; collar-stud abscess; Rx: HRZE × 6 months", ])) story.extend(section_box("Sterilisation & Disinfection", [ "Sterilisation = destruction of all organisms including spores", "Autoclaving: 134°C at 2 bar for 3 min; steam under pressure; gold standard", "Ethylene oxide: Low temperature; for heat-sensitive instruments", "Gamma radiation: Disposable items; industrial", "Disinfection: Destroys vegetative forms but NOT spores", "Antiseptics (on living tissue): Povidone iodine, chlorhexidine, hydrogen peroxide", "Glutaraldehyde: 2% solution; flexible endoscopes (high-level disinfection); 10 hour soak = sterilisation", ])) story.append(PageBreak()) # ═══════════════════════════════════════════════════════════════════════════════ # QUICK REVISION TABLE – SURGICAL HIGH-YIELD FACTS # ═══════════════════════════════════════════════════════════════════════════════ story.append(chap_banner("QUICK REVISION: HIGH-YIELD SURGICAL FACTS", ORANGE)) story.append(Spacer(1, 6)) hiyield = [ ("MC cause of intestinal obstruction in adults", "Adhesions (post-surgery)"), ("MC cause of intestinal obstruction in children", "Intussusception (ileocaecal)"), ("MC organ injured in blunt abdominal trauma", "Spleen"), ("MC hernia to strangulate", "Femoral hernia"), ("MC hernia overall", "Indirect inguinal hernia"), ("Painless jaundice + palpable GB", "Ca head of pancreas (Courvoisier's law)"), ("MC site of carcinoid tumour", "Appendix"), ("Reed-Sternberg cells", "Hodgkin's lymphoma"), ("MC type of thyroid cancer", "Papillary carcinoma"), ("MC benign breast tumour in young women", "Fibroadenoma"), ("MC cause of haemoptysis in young", "Bronchiectasis; carcinoma in elderly"), ("MC cause of PRbleeding in adults", "Haemorrhoids"), ("Carcinoma following chronic scar", "Marjolin's ulcer (SCC)"), ("Anchovy sauce pus", "Amoebic liver abscess"), ("MC venous ulcer site", "Medial malleolus (gaiter area)"), ("Rovsing's sign", "Pain in RIF on palpating LIF – appendicitis"), ("Murphy's sign", "Arrest of inspiration on deep palpation RUQ – acute cholecystitis"), ("Trousseau's sign", "Carpal spasm on inflating BP cuff – hypocalcaemia"), ("Chvostek's sign", "Facial twitch on tapping facial nerve – hypocalcaemia"), ("Beck's triad", "Muffled HS, raised JVP, low BP – cardiac tamponade"), ] hy_rows = [header := [Paragraph("<b><font color='white'>Fact / Sign</font></b>", S("HYH1", fontSize=9.5, fontName="Helvetica-Bold", leading=13)), Paragraph("<b><font color='white'>Answer</font></b>", S("HYH2", fontSize=9.5, fontName="Helvetica-Bold", leading=13))]] for q, a in hiyield: hy_rows.append([Paragraph(q, BULLET), Paragraph(a, BODY)]) hyt = Table(hy_rows, colWidths=[8*cm, 9*cm]) hyt.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), ORANGE), ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LGREY]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#cccccc")), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ("VALIGN", (0,0), (-1,-1), "TOP"), ])) story.append(hyt) story.append(Spacer(1, 0.5*cm)) # MNEMONICS BOX story.append(Paragraph("KEY MNEMONICS FOR SURGERY EXAMS", SEC_HEAD)) mnemonics = [ ("GET SMASHED", "Causes of Acute Pancreatitis: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypothermia, ERCP, Drugs"), ("FRIENDS", "Causes of fistula not healing: Foreign body, Radiation, Infection/IBD, Epithelialisation, Neoplasm, Distal obstruction, Steroids"), ("6 Ps", "Acute limb ischaemia: Pain, Pallor, Paraesthesia, Pulselessness, Paralysis, Perishingly cold"), ("ABCDE (ATLS)", "Airway, Breathing, Circulation, Disability, Exposure"), ("Sepsis 6", "Cultures, Antibiotics, Fluids, Catheter, O2, Lactate (all within 1 hour)"), ("PPP (MEN1)", "Pituitary + Parathyroid + Pancreatic tumours"), ("Courvoisier's Law", "Palpable painless GB + jaundice = NOT stones = carcinoma head of pancreas"), ("Whipple's triad", "Insulinoma: symptoms of hypoglycaemia + low blood glucose + relief with glucose"), ] for m, e in mnemonics: data = [[Paragraph(f"<b>{m}</b>", S("MN1", fontSize=9.5, fontName="Helvetica-Bold", textColor=NAVY, leading=13)), Paragraph(e, S("MN2", fontSize=9, fontName="Helvetica", leading=13))]] mt = Table(data, colWidths=[5*cm, 12*cm]) mt.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,0), LGREY), ("BACKGROUND", (1,0), (1,0), WHITE), ("BOX", (0,0), (-1,-1), 0.5, colors.HexColor("#aaaaaa")), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ("VALIGN", (0,0), (-1,-1), "TOP"), ])) story.append(mt) story.append(Spacer(1, 3)) story.append(PageBreak()) # ─── FINAL PAGE: EXAM TIPS ──────────────────────────────────────────────────── story.append(chap_banner("EXAM TIPS & STUDY STRATEGY", GREEN)) story.append(Spacer(1, 8)) tips = [ "Read each chapter with a focus on CLINICAL FEATURES → INVESTIGATIONS → MANAGEMENT flow", "Practise writing out all classifications (e.g. Duke's, Gustilo, Fontaine, ATLS haemorrhage classes)", "For each major surgery, know: indications, steps, complications", "Revise signs/eponyms from the quick revision table – high-yield in short answers", "For viva exams: always give differential diagnoses before jumping to a single answer", "Memorise the mnemonics – they save time in exams and reduce memory errors", "Use self-testing: cover the 'Answer' column and test yourself on the high-yield table", "Re-read the KEY POINT boxes – these are the examiners' favourite questions", "Practice drawing diagrams: sites of hernia, anatomy of inguinal canal, Hesselbach's triangle", "For clinical surgery postings: always present a case with proper history format (S. Das method)", ] for tip in tips: story.append(Paragraph(f"\u2714 {tip}", S("Tip", fontSize=10, fontName="Helvetica", leading=15, leftIndent=6, spaceAfter=5, textColor=colors.HexColor("#1a1a2e")))) story.append(Spacer(1, 1*cm)) disclaimer_data = [[Paragraph( "<b>DISCLAIMER:</b> These notes are a study aid summarising standard surgical textbook material " "(primarily SRB's Manual of Surgery / Clinical Methods in Surgery). Always cross-reference " "with your prescribed textbook and current clinical guidelines. Drug doses and clinical " "protocols must be verified before clinical application.", S("Disc", fontSize=8.5, fontName="Helvetica-Oblique", leading=13, textColor=colors.HexColor("#555555")))]] dt = Table(disclaimer_data, colWidths=[17*cm]) dt.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), colors.HexColor("#fff3cd")), ("BOX", (0,0), (-1,-1), 0.8, colors.HexColor("#e76f51")), ("TOPPADDING", (0,0), (-1,-1), 8), ("BOTTOMPADDING", (0,0), (-1,-1), 8), ("LEFTPADDING", (0,0), (-1,-1), 10), ])) story.append(dt) # ── BUILD PDF ───────────────────────────────────────────────────────────────── def add_page_number(canvas_obj, doc_obj): canvas_obj.saveState() canvas_obj.setFont("Helvetica", 8) canvas_obj.setFillColor(colors.HexColor("#888888")) canvas_obj.drawString(2*cm, 1.5*cm, "SRB Clinical Surgery – Complete Study Notes") canvas_obj.drawRightString(19*cm, 1.5*cm, f"Page {doc_obj.page}") canvas_obj.restoreState() doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number) print(f"PDF generated: {OUTPUT}") PYEOF

ls -lh /tmp/workspace/srb-surgery/