from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
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 ListFlowable, ListItem

OUTPUT = "/tmp/workspace/pancreatitis-guide/Pancreatitis_Abscess_QuizGuide.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=18*mm, leftMargin=18*mm,
    topMargin=20*mm, bottomMargin=20*mm
)

# ── Colour palette ────────────────────────────────────────────────
NAVY    = colors.HexColor("#1A237E")
BLUE    = colors.HexColor("#1565C0")
LBLUE   = colors.HexColor("#E3F2FD")
TEAL    = colors.HexColor("#00695C")
LTEAL   = colors.HexColor("#E0F2F1")
RED     = colors.HexColor("#B71C1C")
LRED    = colors.HexColor("#FFEBEE")
ORANGE  = colors.HexColor("#E65100")
LORANGE = colors.HexColor("#FFF3E0")
YELLOW  = colors.HexColor("#FFF9C4")
LGRAY   = colors.HexColor("#F5F5F5")
GRAY    = colors.HexColor("#9E9E9E")
BLACK   = colors.black
WHITE   = colors.white

styles = getSampleStyleSheet()

def style(name, **kw):
    s = ParagraphStyle(name, **kw)
    return s

# Custom styles
TITLE_S = style("MyTitle", fontSize=22, fontName="Helvetica-Bold",
                textColor=WHITE, alignment=TA_CENTER, leading=28)
SUBTITLE_S = style("MySubtitle", fontSize=12, fontName="Helvetica",
                   textColor=LBLUE, alignment=TA_CENTER, leading=16)
H1 = style("H1", fontSize=15, fontName="Helvetica-Bold",
           textColor=WHITE, leading=20)
H2 = style("H2", fontSize=12, fontName="Helvetica-Bold",
           textColor=NAVY, leading=16)
H3 = style("H3", fontSize=10, fontName="Helvetica-Bold",
           textColor=TEAL, leading=14)
BODY = style("Body", fontSize=9.5, fontName="Helvetica",
             textColor=BLACK, leading=14, alignment=TA_JUSTIFY)
BULLET = style("Bullet", fontSize=9.5, fontName="Helvetica",
               textColor=BLACK, leading=14, leftIndent=12, bulletIndent=0)
BOLD_BODY = style("BoldBody", fontSize=9.5, fontName="Helvetica-Bold",
                  textColor=BLACK, leading=14)
SMALL = style("Small", fontSize=8.5, fontName="Helvetica-Oblique",
              textColor=GRAY, leading=12)
BOX_BODY = style("BoxBody", fontSize=9.5, fontName="Helvetica",
                 textColor=BLACK, leading=14, leftIndent=6)
RED_BOLD = style("RedBold", fontSize=9.5, fontName="Helvetica-Bold",
                 textColor=RED, leading=14)
KEY_BOX = style("KeyBox", fontSize=10, fontName="Helvetica-Bold",
                textColor=NAVY, leading=14)

def spacer(h=4):
    return Spacer(1, h*mm)

def hline(color=BLUE, thickness=0.8):
    return HRFlowable(width="100%", thickness=thickness, color=color, spaceAfter=2)

def section_header(text, bg=BLUE):
    data = [[Paragraph(text, H1)]]
    t = Table(data, colWidths=[174*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("ROUNDEDCORNERS", [4,4,4,4]),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING", (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ]))
    return t

def sub_header(text):
    return Paragraph(f"<b>{text}</b>", H2)

def body_p(text):
    return Paragraph(text, BODY)

def bold_p(text):
    return Paragraph(text, BOLD_BODY)

def bullet_list(items):
    elems = []
    for item in items:
        elems.append(Paragraph(f"• {item}", BULLET))
    return elems

def info_box(title, items, bg=LBLUE, title_color=NAVY):
    title_style = style(f"IB_{title[:5]}", fontSize=10, fontName="Helvetica-Bold",
                        textColor=title_color, leading=14)
    rows = [[Paragraph(title, title_style)]]
    for item in items:
        rows.append([Paragraph(f"• {item}", BOX_BODY)])
    t = Table(rows, colWidths=[174*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (0,0), bg),
        ("BACKGROUND", (0,1), (-1,-1), LGRAY),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("BOX", (0,0), (-1,-1), 0.8, BLUE),
        ("LINEBELOW", (0,0), (0,0), 0.8, BLUE),
    ]))
    return t

def warning_box(title, items):
    return info_box(title, items, bg=LRED, title_color=RED)

def two_col_table(headers, rows, col_widths=None):
    if col_widths is None:
        col_widths = [87*mm, 87*mm]
    h_style = style("TH", fontSize=9.5, fontName="Helvetica-Bold",
                    textColor=WHITE, leading=13)
    cell_style = style("TC", fontSize=9, fontName="Helvetica",
                       textColor=BLACK, leading=13)
    data = [[Paragraph(h, h_style) for h in headers]]
    for row in rows:
        data.append([Paragraph(str(c), cell_style) for c in row])
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LBLUE]),
        ("GRID", (0,0), (-1,-1), 0.5, GRAY),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    return t

# ══════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ══════════════════════════════════════════════════════════════════
story = []

# ── COVER ────────────────────────────────────────────────────────
cover_data = [[
    Paragraph("SURGERY QUIZ GUIDE", TITLE_S),
], [
    Paragraph("Pancreatitis & Pancreatic Abscess", SUBTITLE_S),
], [
    Paragraph("Based on Schwartz's Principles of Surgery, 11th Edition", SMALL),
]]
cover = Table(cover_data, colWidths=[174*mm])
cover.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), NAVY),
    ("TOPPADDING", (0,0), (-1,-1), 12),
    ("BOTTOMPADDING", (0,0), (-1,-1), 12),
    ("LEFTPADDING", (0,0), (-1,-1), 16),
    ("RIGHTPADDING", (0,0), (-1,-1), 16),
    ("ROUNDEDCORNERS", [8,8,8,8]),
]))
story += [spacer(8), cover, spacer(6)]
story.append(body_p("<i>Reference: Schwartz's Principles of Surgery, 11th Ed. | For quiz preparation</i>"))
story.append(spacer(3))
story.append(hline())
story.append(spacer(2))

# ══════════════════════════════════════════════════════════════════
# PART 1: ACUTE PANCREATITIS
# ══════════════════════════════════════════════════════════════════
story.append(section_header("PART 1: ACUTE PANCREATITIS", NAVY))
story.append(spacer(3))

# 1. DEFINITION
story.append(sub_header("1. Definition"))
story.append(body_p(
    "Acute pancreatitis is an <b>inflammatory disorder of the pancreas</b> characterized by "
    "<b>edema</b> and, when severe, <b>necrosis</b>. It ranges from mild, self-limiting inflammation "
    "to severe and critical disease with infected pancreatic necrosis, multiple organ failure, and high "
    "mortality. The most common inpatient principal GI discharge diagnosis in the USA (~274,000/year). "
    "Worldwide incidence: 5–80 per 100,000 population."
))
story.append(spacer(3))

# 2. ETIOLOGY
story.append(sub_header("2. Etiology (Causes)"))
story.append(body_p("<b>Gallstones + Alcohol = 80% of all cases</b> (most common causes)"))
story.append(spacer(2))
etiology_data = [
    ["Cause", "Key Notes"],
    ["Gallstones", "Stone impaction at sphincter of Oddi → ductal hypertension → enzyme activation. Transient LFT derangement. Stones in feces within 10 days (88% vs 11%)."],
    ["Alcohol", "100–150 g/day. Ethanol → acinar cell injury, stellate cell activation, sphincter spasm. Burst secretion + spasm incites pancreatitis."],
    ["ERCP (Iatrogenic)", "5–10% of ERCP procedures. High-pressure contrast infusion. Risk reduced by prophylactic rectal NSAIDs."],
    ["Hyperlipidemia", "Types I & V hyperlipoproteinemia. Lipase liberates toxic fatty acids → microcirculatory impairment."],
    ["Hypercalcemia", "Elevated Ca²⁺ activates trypsinogen directly."],
    ["Drugs", "Thiazides, furosemide, estrogens, steroids (children), propofol, chemotherapy agents."],
    ["Trauma", "External trauma, surgical trauma (gastrectomy, splenectomy), ischemia (cardiopulmonary bypass)."],
    ["Hereditary", "Mutations causing elevated intracellular trypsin activation."],
    ["Others", "Pancreatic duct obstruction (neoplasm, pancreas divisum), infections, venom, idiopathic."],
]
story.append(two_col_table(etiology_data[0], etiology_data[1:], col_widths=[50*mm, 124*mm]))
story.append(spacer(4))

# 3. PATHOPHYSIOLOGY
story.append(sub_header("3. Pathophysiology"))
story.append(body_p(
    "<b>Key concept (Chiari, 1896):</b> Premature intrapancreatic activation of digestive enzymes "
    "→ 'auto-digestion' of the pancreas."
))
story.append(spacer(2))
path_steps = [
    "<b>Trigger:</b> Any causative factor (gallstone, alcohol, etc.) → injurious stimulus to acinar cells",
    "<b>Step 1:</b> Intra-acinar activation of trypsinogen → active trypsin (key precipitating event)",
    "<b>Step 2:</b> Trypsin activates other zymogens: elastase, phospholipase A2, lipase, chymotrypsin",
    "<b>Step 3:</b> Inflammatory cell recruitment (neutrophils, macrophages) → cytokine release (TNF-α, IL-1, IL-6)",
    "<b>Step 4:</b> Local damage → pancreatic edema → fat necrosis → hemorrhagic necrosis (severe cases)",
    "<b>Step 5:</b> Systemic inflammatory response (SIRS) → multi-organ dysfunction/failure (MODS/ARDS/ARF)",
    "<b>Intestinal component:</b> Gut mucosal barrier dysfunction → bacterial translocation → infected necrosis",
    "<b>Alcohol specific:</b> Ethanol → acinar cell changes + stellate cell activation (myofibroblast phenotype) → proinflammatory mediators",
    "<b>Gallstone specific:</b> Ductal hypertension → backpressure → minor ductal disruption → extravasation of pancreatic juice",
]
story += bullet_list(path_steps)
story.append(spacer(4))

# 4. PATIENT PRESENTATION
story.append(sub_header("4. Patient Presentation (How the patient comes in)"))
story.append(spacer(2))
pres_box_data = [[
    Paragraph("CLASSIC PRESENTATION", style("CPH", fontSize=10, fontName="Helvetica-Bold",
              textColor=WHITE, leading=14)),
    Paragraph("ASSOCIATED FEATURES", style("AFH", fontSize=10, fontName="Helvetica-Bold",
              textColor=WHITE, leading=14)),
]]
cell_s = style("CS", fontSize=9, fontName="Helvetica", textColor=BLACK, leading=13)
pres_items = [
    "Sudden onset severe epigastric pain",
    "Radiates to mid-back (band-like)",
    "Nausea and vomiting (does NOT relieve pain)",
    "Worsened by eating; relieved leaning forward",
    "History of alcohol binge / gallstones",
    "Fever (low-grade in mild, high in severe/infected)",
]
assoc_items = [
    "Tachycardia, hypotension (severe disease)",
    "Abdominal distension, ileus",
    "Icterus/jaundice (gallstone etiology)",
    "Cullen's sign: periumbilical bruising (retroperitoneal bleed)",
    "Grey Turner's sign: flank bruising (retroperitoneal bleed)",
    "Tetany (hypocalcemia — rare)",
    "Altered mental status (severe/alcohol withdrawal)",
]
pres_col = "\n".join([f"• {i}" for i in pres_items])
assoc_col = "\n".join([f"• {i}" for i in assoc_items])
pres_data = [
    [Paragraph("CLASSIC PRESENTATION", style("CPH2", fontSize=10, fontName="Helvetica-Bold",
              textColor=WHITE, leading=14)),
     Paragraph("ASSOCIATED FEATURES", style("AFH2", fontSize=10, fontName="Helvetica-Bold",
              textColor=WHITE, leading=14))],
    [Paragraph(pres_col, cell_s), Paragraph(assoc_col, cell_s)],
]
pt = Table(pres_data, colWidths=[87*mm, 87*mm])
pt.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (0,0), BLUE),
    ("BACKGROUND", (1,0), (1,0), TEAL),
    ("BACKGROUND", (0,1), (0,1), LBLUE),
    ("BACKGROUND", (1,1), (1,1), LTEAL),
    ("GRID", (0,0), (-1,-1), 0.5, GRAY),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
    ("RIGHTPADDING", (0,0), (-1,-1), 8),
    ("TOPPADDING", (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(pt)
story.append(spacer(2))
story.append(warning_box("⚠ KEY CLINICAL SIGNS TO REMEMBER",
    ["Cullen's sign = periumbilical ecchymosis (retroperitoneal hemorrhage)",
     "Grey Turner's sign = flank ecchymosis (retroperitoneal hemorrhage)",
     "Both signs = severe hemorrhagic pancreatitis; RARE but HIGH-YIELD for exams",
     "Morphine is AVOIDED (causes sphincter of Oddi spasm) — use buprenorphine/pethidine"]))
story.append(spacer(4))

# 5. DIAGNOSIS AND INVESTIGATIONS
story.append(sub_header("5. Diagnosis & Investigations"))
story.append(body_p(
    "<b>Diagnostic criteria (2 of 3 must be present):</b> (1) Abdominal pain consistent with AP; "
    "(2) Serum amylase OR lipase >3× upper limit of normal; (3) Characteristic CT findings."
))
story.append(spacer(3))

inv_data = [
    ["Investigation", "Finding / Significance"],
    ["Serum Amylase", "Rises within hours, peaks in few hours, lasts 3–5 days. NOT correlated with severity (mild AP can have HIGHER amylase). Can be normal in hyperlipidemia (lipid interference) or severe necrosis."],
    ["Serum Lipase", "More specific and sensitive than amylase. Preferred enzyme marker. Stays elevated longer."],
    ["Urinary Amylase", "Stays elevated days after serum normalizes. Useful when serum levels normalized."],
    ["LFTs (ALT, AST, Bilirubin)", "Elevated in gallstone pancreatitis. ALT >150 U/L is highly predictive of gallstone etiology."],
    ["Serum Calcium", "Low (<8 mg/dL) = sign of severity (Ranson's criteria). Saponification of fat uses calcium."],
    ["Blood Glucose", ">200 mg/dL (or >220 mg/dL for gallstone) = Ranson's criterion."],
    ["WBC Count", ">16,000/mm³ (or >18,000 for gallstone) at admission = Ranson's criterion."],
    ["LDH", ">350 IU/L (or >400 for gallstone) = Ranson's criterion."],
    ["C-Reactive Protein (CRP)", ">150 mg/dL at 24h = severity predictor, equivalent to Ranson's/APACHE II."],
    ["BUN / Creatinine", "Elevated = azotemia. Rise in BUN >5 mg/dL (>2 for gallstone) in 48h = Ranson's."],
    ["Hematocrit", "Fall >10 points in 48h = Ranson's criterion (fluid sequestration)."],
    ["Arterial blood gas (ABG)", "PaO₂ <60 mmHg = Ranson's criterion; signals ARDS/respiratory failure."],
    ["Base excess / deficit", "Base deficit >4 mEq/L (or >5 for gallstone) = Ranson's criterion."],
    ["Fluid sequestration", ">6 L (or >4 L for gallstone) = Ranson's criterion."],
    ["Ultrasound abdomen", "First imaging: detect gallstones, biliary dilation, pericholecystic fluid. Limited for pancreas (bowel gas)."],
    ["Contrast-Enhanced CT (CECT)", "Gold standard for severity, necrosis, complications. Not needed routinely in first week unless deterioration. Uses Balthazar grading / CT Severity Index (CTSI)."],
    ["MRCP", "Non-invasive biliary imaging; detects CBD stones. Preferred over ERCP for diagnosis."],
    ["ERCP", "Only for CONCOMITANT CHOLANGITIS with gallstone pancreatitis (NOT for diagnosis alone or cholestasis)."],
]
story.append(two_col_table(inv_data[0], inv_data[1:], col_widths=[46*mm, 128*mm]))
story.append(spacer(4))

# 6. SEVERITY ASSESSMENT
story.append(sub_header("6. Severity Assessment / Scoring Systems"))
story.append(spacer(2))

# Ranson's table
rans_style = style("RS", fontSize=9, fontName="Helvetica", textColor=BLACK, leading=13)
rans_hdr = style("RH", fontSize=9.5, fontName="Helvetica-Bold", textColor=WHITE, leading=13)
ranson_header = [
    [Paragraph("RANSON'S CRITERIA (Non-Gallstone)", rans_hdr),
     Paragraph("RANSON'S CRITERIA (Gallstone)", rans_hdr)],
    [Paragraph("<b>AT ADMISSION</b>", rans_hdr), Paragraph("<b>AT ADMISSION</b>", rans_hdr)],
]
ranson_admit = [
    ["Age >55 years", "Age >70 years"],
    ["WBC >16,000/mm³", "WBC >18,000/mm³"],
    ["Blood glucose >200 mg/dL", "Blood glucose >220 mg/dL"],
    ["Serum LDH >350 IU/L", "Serum LDH >400 IU/L"],
    ["Serum AST >250 U/dL", "Serum AST >250 U/dL"],
]
ranson_48 = [
    ["<b>WITHIN 48 HOURS</b>", "<b>WITHIN 48 HOURS</b>"],
    ["Hematocrit fall >10 points", "Hematocrit fall >10 points"],
    ["BUN elevation >5 mg/dL", "BUN elevation >2 mg/dL"],
    ["Serum calcium <8 mg/dL", "Serum calcium <8 mg/dL"],
    ["PaO₂ <60 mmHg", "(not included)"],
    ["Base deficit >4 mEq/L", "Base deficit >5 mEq/L"],
    ["Fluid sequestration >6 L", "Fluid sequestration >4 L"],
]
all_rows = ranson_header + [[Paragraph(a, rans_style), Paragraph(b, rans_style)]
                             for a, b in ranson_admit]
all_rows += [[Paragraph(a, rans_hdr if "<b>" in a else rans_style),
              Paragraph(b, rans_hdr if "<b>" in b else rans_style)]
             for a, b in ranson_48]

rt = Table(all_rows, colWidths=[87*mm, 87*mm])
rt.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), NAVY),
    ("BACKGROUND", (0,1), (-1,1), BLUE),
    ("BACKGROUND", (0,6), (-1,6), TEAL),
    ("ROWBACKGROUNDS", (0,2), (-1,5), [WHITE, LBLUE]),
    ("ROWBACKGROUNDS", (0,7), (-1,-1), [WHITE, LTEAL]),
    ("GRID", (0,0), (-1,-1), 0.5, GRAY),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("TOPPADDING", (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("SPAN", (0,0), (0,0)), # keep as is
]))
story.append(rt)
story.append(spacer(2))
story.append(info_box("RANSON'S SCORE INTERPRETATION",
    ["<3 criteria → Mild, uncomplicated disease (mortality <1%)",
     "3–6 criteria → Moderate-severe disease (mortality ~15%)",
     ">6 criteria → Severe disease, mortality RISK ~50%",
     "Cannot be assessed in first 48h — needs full 48h data"],
    bg=YELLOW, title_color=ORANGE))
story.append(spacer(3))

story.append(body_p("<b>Other Scoring Systems:</b>"))
story += bullet_list([
    "APACHE II score ≥8 at 24h = severe pancreatitis (same accuracy as Ranson's)",
    "CRP >150 mg/dL at 24h = severity (equivalent to Ranson's/APACHE II)",
    "BISAP score: BUN >25 + impaired mental status + SIRS + age >60 + pleural effusion (1 point each; ≥3 = severe)",
    "SIRS presence has prognostic significance",
    "CT Severity Index (CTSI / Balthazar grading): CT-based scoring for pancreatic/peripancreatic inflammation and necrosis",
    "HAPS score: assessed early (within 4h) — helps triage",
])
story.append(spacer(4))

# 7. MANAGEMENT
story.append(section_header("7. Management of Acute Pancreatitis", TEAL))
story.append(spacer(3))

story.append(sub_header("Step 1: Initial Assessment (First 4 hours)"))
story += bullet_list([
    "Adequate analgesia (IV route — buprenorphine 0.3 mg/4h IV, or NSAIDs for mild pain)",
    "AVOID MORPHINE (causes sphincter of Oddi spasm)",
    "IV fluid resuscitation (aggressive early resuscitation — Ringer's lactate preferred)",
    "Predict severity: Ranson's criteria, HAPS score",
    "Assess systemic response: SIRS score, SOFA score (organ failure)",
    "Ultrasound for gallstones/biliary sludge",
    "History of alcohol consumption",
    "Lab evaluation of other causes",
    "MRCP and/or URGENT ERCP only if concomitant cholangitis",
    "Transfer to ICU or specialist center if needed",
])
story.append(spacer(2))

story.append(sub_header("Step 2: Reassessment (4–6 hours)"))
story += bullet_list([
    "Assess response to fluid resuscitation: MAP, heart rate, urine output, hematocrit",
    "Determine etiology",
    "Commence ENTERAL NUTRITION once normovolemia restored (usually after 6h)",
    "NG tube feeding if no gastric stasis; advance to NJ tube if needed",
    "NO prophylactic antibiotics (not indicated for sterile pancreatitis)",
    "No routine NPO — early enteral feeding reduces infected necrosis via reducing gut bacterial translocation",
])
story.append(spacer(2))

story.append(sub_header("Step 3: Conservative Management & Monitoring (Daily)"))
story += bullet_list([
    "Clinical evaluation daily",
    "Assess cardiovascular, respiratory, and renal function",
    "Detect peritonitis and abdominal compartment syndrome",
    "Daily CRP",
    "Classify severity daily (mild, moderate, severe, critical)",
    "Detect intolerance of NG enteral nutrition",
    "Consider supplemental parenteral nutrition by Day 4 if enteral route fails",
])
story.append(spacer(2))

story.append(sub_header("Step 4: Indications for CECT 'Pancreatic Protocol' (Rarely in first week)"))
story += bullet_list([
    "Significant clinical deterioration + elevated CRP",
    "Suspicion of local pancreatic complications",
    "Suspected bowel ischemia",
    "Acute bleeding (CTA — if stable; consider embolization)",
    "Abdominal compartment syndrome",
])
story.append(spacer(2))

story.append(sub_header("Step 5: Invasive Intervention (Step-Up Approach)"))
story.append(info_box("STEP-UP APPROACH (for suspected infected local complications)",
    ["1st line: CT/EUS-guided PERCUTANEOUS or ENDOSCOPIC DRAINAGE",
     "Delay intervention 3–4 weeks with ICU support if possible (necrosis becomes walled off)",
     "If drainage fails or secondary deterioration: minimally invasive techniques (VARD / endoscopic transluminal debridement / percutaneous nephroscopic debridement)",
     "Ongoing large-bore drainage and irrigation",
     "Open necrosectomy / LAPAROTOMY only if:",
     "  — Step-up approach fails",
     "  — Acute abdomen (perforation or ischemia)",
     "  — Severe abdominal compartment syndrome"],
    bg=LORANGE, title_color=ORANGE))
story.append(spacer(2))

story.append(sub_header("Biliary Pancreatitis — Special Considerations"))
story += bullet_list([
    "ERCP indicated ONLY if concomitant cholangitis (NOT just for cholestasis or predicted severe disease)",
    "Cholecystectomy: should be performed BEFORE discharge in mild gallstone pancreatitis",
    "In severe disease: delay cholecystectomy until recovery",
])
story.append(spacer(4))

# 8. COMPLICATIONS
story.append(section_header("8. Complications of Acute Pancreatitis", NAVY))
story.append(spacer(3))

story.append(sub_header("LOCAL Complications"))
story += bullet_list([
    "Pancreatic phlegmon (inflammatory mass)",
    "Pancreatic abscess",
    "Pancreatic pseudocyst (fluid collection >6 weeks, surrounded by granulation/fibrous wall)",
    "Pancreatic ascites",
    "Involvement of adjacent organs: hemorrhage, thrombosis (portal vein, splenic vein), bowel infarction, obstructive jaundice, fistula formation, mechanical obstruction",
])
story.append(spacer(2))

story.append(sub_header("SYSTEMIC Complications"))
comp_data = [
    ["System", "Complication"],
    ["Pulmonary", "Pneumonia, atelectasis, ARDS, pleural effusion"],
    ["Cardiovascular", "Hypotension, hypovolemia, sudden death, ST-T changes, pericardial effusion"],
    ["Hematologic", "Hemoconcentration, DIC"],
    ["GI Hemorrhage", "Peptic ulcer, erosive gastritis, portal/splenic vein thrombosis with varices"],
    ["Renal", "Oliguria, azotemia, renal artery/vein thrombosis"],
    ["Metabolic", "Hyperglycemia, hypocalcemia, hypertriglyceridemia, encephalopathy, Purtscher's retinopathy (sudden blindness)"],
    ["CNS", "Psychosis, fat emboli, alcohol withdrawal syndrome"],
    ["Fat Necrosis", "Intra-abdominal saponification, subcutaneous tissue necrosis"],
]
story.append(two_col_table(comp_data[0], comp_data[1:], col_widths=[38*mm, 136*mm]))
story.append(spacer(4))

# ══════════════════════════════════════════════════════════════════
# PART 2: PANCREATIC ABSCESS
# ══════════════════════════════════════════════════════════════════
story.append(PageBreak())
story.append(section_header("PART 2: PANCREATIC ABSCESS", RED))
story.append(spacer(3))

# DEFINITION
story.append(sub_header("1. Definition"))
story.append(body_p(
    "A <b>pancreatic abscess</b> is a circumscribed intra-abdominal collection of pus, usually in proximity "
    "to the pancreas, containing little or no pancreatic necrosis. It is a <b>local complication of acute "
    "pancreatitis</b>. Occurs in <b>10–15% of patients</b> with severe pancreatitis with necrosis "
    "(Schwartz's, Ch. 6)."
))
story.append(spacer(2))
story.append(info_box("PANCREATIC ABSCESS vs INFECTED NECROSIS",
    ["Pancreatic ABSCESS: pus collection, little/no necrosis, BETTER prognosis",
     "Infected pancreatic NECROSIS: infected devitalized pancreatic tissue, HIGHER mortality",
     "Both require intervention — step-up approach applies to both",
     "Distinction: CT scan — abscess = fluid collection; infected necrosis = solid/mixed density"],
    bg=LRED, title_color=RED))
story.append(spacer(3))

# TIMING
story.append(sub_header("2. Timing of Development"))
story += bullet_list([
    "Typically develops 3–4+ WEEKS after onset of severe acute pancreatitis",
    "Patient may initially improve then deteriorate ('secondary deterioration')",
    "Early (first week): systemic inflammatory response predominates; abscesses form later",
])
story.append(spacer(3))

# PATIENT PRESENTATION / SYMPTOMS
story.append(sub_header("3. Patient Presentation"))
story.append(spacer(2))

pres2_data = [
    [Paragraph("SYMPTOMS", style("PH2", fontSize=10, fontName="Helvetica-Bold",
              textColor=WHITE, leading=14)),
     Paragraph("SIGNS (Physical Examination)", style("PH3", fontSize=10, fontName="Helvetica-Bold",
              textColor=WHITE, leading=14))],
    [
        Paragraph(
            "• Fever (high-grade, persistent or recurrent)\n"
            "• Abdominal pain (epigastric/upper abdomen)\n"
            "• Nausea and vomiting\n"
            "• General malaise / weakness\n"
            "• Failure to improve after initial AP treatment\n"
            "• 'Secondary deterioration' — patient who improved initially, now worsens at 2–3 weeks",
            cell_s),
        Paragraph(
            "• Fever (38–40°C)\n"
            "• Tachycardia\n"
            "• Epigastric / upper abdominal tenderness\n"
            "• Palpable tender mass (upper abdomen) — in some\n"
            "• Signs of sepsis: hypotension, tachypnea, altered mentation\n"
            "• Jaundice (if biliary compression)\n"
            "• Leukocytosis on examination impression",
            cell_s),
    ]
]
pt2 = Table(pres2_data, colWidths=[87*mm, 87*mm])
pt2.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (0,0), RED),
    ("BACKGROUND", (1,0), (1,0), colors.HexColor("#880E4F")),
    ("BACKGROUND", (0,1), (0,1), LRED),
    ("BACKGROUND", (1,1), (1,1), colors.HexColor("#FCE4EC")),
    ("GRID", (0,0), (-1,-1), 0.5, GRAY),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
    ("RIGHTPADDING", (0,0), (-1,-1), 8),
    ("TOPPADDING", (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(pt2)
story.append(spacer(4))

# DIAGNOSIS / INVESTIGATIONS
story.append(sub_header("4. Diagnosis & Investigations"))
story.append(spacer(2))

inv2_data = [
    ["Investigation", "Finding / Significance"],
    ["Blood Tests", "Leukocytosis (elevated WBC count), elevated CRP, fever, elevated ESR"],
    ["Blood cultures", "May be positive — bacteremia from gut translocation (E. coli, Klebsiella, Pseudomonas, Bacteroides, Enterococcus — common organisms)"],
    ["Serum amylase/lipase", "May be elevated but less reliable at this stage (3+ weeks later)"],
    ["LFTs", "Elevated if biliary involvement"],
    ["Contrast-Enhanced CT Scan", "INVESTIGATION OF CHOICE. Shows peripancreatic fluid collection ± gas bubbles within collection (PATHOGNOMONIC for infection). Evaluates extent of necrosis. CT-guided aspiration for Gram stain and culture."],
    ["CT-guided aspiration", "Gram stain + culture from CT-guided aspiration of pancreatic bed fluid. POSITIVE = mandates surgical intervention. Gas on CT alone also mandates intervention."],
    ["MRI / MRCP", "Alternative to CT; better soft tissue contrast; useful if CT contraindicated"],
    ["Ultrasound", "Less sensitive for pancreatic abscess due to bowel gas; may show fluid collection"],
]
story.append(two_col_table(inv2_data[0], inv2_data[1:], col_widths=[46*mm, 128*mm]))
story.append(spacer(2))
story.append(warning_box("KEY DIAGNOSTIC POINT",
    ["GAS within pancreatic/peripancreatic collection on CT = INFECTED = MUST INTERVENE surgically",
     "CT-guided aspiration: Positive Gram stain OR culture = MUST INTERVENE surgically",
     "Sterile collections should NOT be drained (introduces infection risk)"]))
story.append(spacer(4))

# MICROBIOLOGY
story.append(sub_header("5. Microbiology of Pancreatic Abscess"))
story += bullet_list([
    "Secondary infection via gut bacterial translocation across damaged intestinal barrier",
    "Common organisms: E. coli, Klebsiella pneumoniae, Pseudomonas spp., Enterococcus spp.",
    "Anaerobes: Bacteroides spp., anaerobic streptococci",
    "Fungal (rare): Candida albicans — in immunocompromised or prolonged antibiotic use",
    "Antibiotics: NOT prophylactic; used when INFECTION IS CONFIRMED",
])
story.append(spacer(4))

# TREATMENT
story.append(sub_header("6. Treatment of Pancreatic Abscess"))
story.append(spacer(2))
story.append(info_box("TREATMENT STRATEGY: STEP-UP APPROACH",
    ["Step 1: Resuscitation + IV antibiotics (broad spectrum: cover gram-negatives, anaerobes — e.g., imipenem/meropenem or piperacillin-tazobactam)",
     "Step 2: CT-guided PERCUTANEOUS DRAINAGE (first-line intervention) — large bore drain placement",
     "Step 3: If percutaneous drainage fails → Minimally invasive surgical drainage:",
     "  • Video-Assisted Retroperitoneal Debridement (VARD)",
     "  • Percutaneous nephroscopic debridement",
     "  • Endoscopic transluminal drainage/debridement (EUS-guided)",
     "Step 4: Open surgical drainage / necrosectomy — LAST RESORT (significant morbidity)",
     "Delay intervention 3–4 weeks if possible (abscess walls off better; safer drainage)",
    ],
    bg=LORANGE, title_color=ORANGE))
story.append(spacer(3))

trt2_data = [
    ["Treatment", "Details"],
    ["IV Antibiotics", "Broad-spectrum — imipenem/meropenem (best pancreatic tissue penetration), piperacillin-tazobactam, ciprofloxacin + metronidazole. Duration: based on clinical response."],
    ["Percutaneous CT-guided drainage", "First-line for accessible collections. Large bore catheter. Culture-directed antibiotics from drained fluid."],
    ["Endoscopic drainage (EUS-guided)", "Transmural drainage for collections adjacent to stomach/duodenum. Endoscopic necrosectomy if needed."],
    ["VARD (Video-Assisted Retroperitoneal Debridement)", "Minimally invasive surgical option via percutaneous access. Less morbidity than open."],
    ["Open necrosectomy", "Reserved for failed step-up, acute abdomen, perforation, or ischemia. Repeated debridements may be needed."],
    ["Nutritional support", "Enteral nutrition (nasojejunal) preferred. Reduces bacterial translocation. Parenteral if enteral not tolerated."],
    ["Treat underlying cause", "Cholecystectomy for gallstone etiology (after recovery). Alcohol cessation counselling."],
]
story.append(two_col_table(trt2_data[0], trt2_data[1:], col_widths=[54*mm, 120*mm]))
story.append(spacer(4))

# PROGNOSIS
story.append(sub_header("7. Prognosis"))
story += bullet_list([
    "Pancreatic abscess: lower mortality than infected necrosis",
    "Infected necrosis: historically ~20–40% mortality; improved with step-up approach",
    "Open necrosectomy associated with significant morbidity and prolonged hospitalization",
    "Step-up approach reduces organ failure and mortality vs open surgery",
    "Early enteral feeding reduces development of infected necrosis",
])
story.append(spacer(4))

# ══════════════════════════════════════════════════════════════════
# PART 3: QUICK COMPARISON TABLE
# ══════════════════════════════════════════════════════════════════
story.append(section_header("PART 3: QUICK COMPARISON — ACUTE PANCREATITIS vs PANCREATIC ABSCESS", TEAL))
story.append(spacer(3))

comp2_data = [
    ["Feature", "Acute Pancreatitis", "Pancreatic Abscess"],
    ["Definition", "Inflammatory disorder of pancreas (edema ± necrosis)", "Intra-abdominal pus collection near pancreas, little/no necrosis"],
    ["Timing", "Acute presentation", "3–4 weeks after onset of severe AP"],
    ["Main cause", "Gallstones (40%), Alcohol (40%)", "Secondary infection complicating severe AP"],
    ["Key symptom", "Sudden severe epigastric pain radiating to back", "Persistent/recurrent fever, epigastric pain, failure to improve"],
    ["Key signs", "Guarding, Cullen's sign, Grey Turner's sign", "High fever, tachycardia, sepsis, ± palpable mass"],
    ["Main investigation", "Serum amylase/lipase (>3× ULN), CECT", "CECT (gas in collection), CT-guided aspiration"],
    ["Pathognomonic finding", "—", "Gas bubbles in peripancreatic collection on CT"],
    ["Severity scoring", "Ranson's, APACHE II, CRP, BISAP, CTSI", "CTSI, organ failure scores"],
    ["1st line treatment", "IV fluids, analgesia, early enteral feeding", "IV antibiotics + CT-guided percutaneous drainage"],
    ["Surgery indication", "Failed step-up, perforation, ischemia, ACS", "Failed step-up, gas on CT or positive aspiration"],
    ["Antibiotics", "NOT prophylactic", "YES — broad spectrum (imipenem/piperacillin-tazobactam)"],
    ["Prognosis", "Mild: <1% mortality. Severe: up to 50% (>6 Ranson)", "Lower mortality than infected necrosis; improves with step-up"],
]
story.append(two_col_table(
    comp2_data[0],
    comp2_data[1:],
    col_widths=[40*mm, 67*mm, 67*mm]
))
story.append(spacer(4))

# ── HIGH-YIELD EXAM BOXES ─────────────────────────────────────────
story.append(section_header("PART 4: HIGH-YIELD EXAM POINTS (MUST KNOW)", RED))
story.append(spacer(3))

hy_data = [
    ["HIGH-YIELD POINT", "DETAIL"],
    ["Morphine is CONTRAINDICATED in AP", "Causes sphincter of Oddi spasm — use buprenorphine, pethidine, or NSAIDs"],
    ["Cullen's sign", "Periumbilical bruising — retroperitoneal hemorrhage (severe/hemorrhagic AP)"],
    ["Grey Turner's sign", "Flank bruising — retroperitoneal hemorrhage (severe/hemorrhagic AP)"],
    ["Ranson's criteria >6", "~50% mortality risk"],
    ["Ranson's criteria <3", "Mild, uncomplicated AP"],
    ["NO prophylactic antibiotics in AP", "Not indicated for sterile pancreatitis"],
    ["ERCP indication in AP", "ONLY with concomitant cholangitis — NOT for cholestasis or predicted severity alone"],
    ["Best analgesic for AP", "Buprenorphine (IV) or pethidine; NSAIDs for mild pain"],
    ["Amylase vs severity", "NO correlation — mild AP may have higher amylase than severe AP"],
    ["Early enteral nutrition", "NG or NJ route; reduces bacterial translocation → reduces infected necrosis"],
    ["Gas on CT = infected", "Gas within pancreatic/peripancreatic collection = infected necrosis/abscess → MUST operate"],
    ["Step-up approach", "Drain first (percutaneous/endoscopic) → minimally invasive → open (last resort)"],
    ["Cholecystectomy timing", "Before discharge in mild gallstone AP; delay in severe AP until recovery"],
    ["Amylase in hyperlipidemia", "May appear NORMAL (lipid interference) — use lipase or urinary amylase"],
    ["Purtscher's retinopathy", "Sudden blindness — rare systemic complication of severe AP"],
    ["Secondary deterioration", "Patient improves then worsens at 2–3 weeks → suspect infected necrosis/abscess"],
]
story.append(two_col_table(hy_data[0], hy_data[1:], col_widths=[70*mm, 104*mm]))
story.append(spacer(4))

# Footer reference
story.append(hline())
story.append(Paragraph(
    "Reference: Schwartz's Principles of Surgery, 11th Edition (Chapter 33 — Pancreas) | "
    "All clinical data sourced from Schwartz's textbook | Created for quiz preparation",
    SMALL
))

# BUILD
doc.build(story)
print(f"PDF created: {OUTPUT}")