from docx import Document
from docx.shared import Pt, Inches, RGBColor, Cm
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL
from docx.oxml.ns import qn
from docx.oxml import OxmlElement
import datetime

doc = Document()

# ── Page margins ──────────────────────────────────────────────
section = doc.sections[0]
section.top_margin    = Cm(2.0)
section.bottom_margin = Cm(2.0)
section.left_margin   = Cm(2.5)
section.right_margin  = Cm(2.5)

# ── Styles ────────────────────────────────────────────────────
normal_style = doc.styles['Normal']
normal_style.font.name = 'Calibri'
normal_style.font.size = Pt(11)

h1 = doc.styles['Heading 1']
h1.font.name = 'Calibri'
h1.font.size = Pt(16)
h1.font.bold = True
h1.font.color.rgb = RGBColor(0x1F, 0x49, 0x7D)

h2 = doc.styles['Heading 2']
h2.font.name = 'Calibri'
h2.font.size = Pt(13)
h2.font.bold = True
h2.font.color.rgb = RGBColor(0x2E, 0x74, 0xB5)

h3 = doc.styles['Heading 3']
h3.font.name = 'Calibri'
h3.font.size = Pt(11)
h3.font.bold = True
h3.font.color.rgb = RGBColor(0x1F, 0x49, 0x7D)

# ── Helper functions ──────────────────────────────────────────
def add_colored_para(doc, text, bg_hex, font_size=10.5, bold=False):
    """Add a paragraph with background shading."""
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(4)
    p.paragraph_format.space_after  = Pt(4)
    p.paragraph_format.left_indent  = Inches(0.1)
    run = p.add_run(text)
    run.font.name = 'Calibri'
    run.font.size = Pt(font_size)
    run.bold = bold
    # shading
    pPr = p._p.get_or_add_pPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), bg_hex)
    pPr.append(shd)
    return p

def set_cell_bg(cell, hex_color):
    tc = cell._tc
    tcPr = tc.get_or_add_tcPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), hex_color)
    tcPr.append(shd)

def set_cell_text(cell, text, bold=False, font_size=10, color_rgb=None, align=WD_ALIGN_PARAGRAPH.LEFT):
    cell.text = ''
    p = cell.paragraphs[0]
    p.alignment = align
    run = p.add_run(text)
    run.font.name = 'Calibri'
    run.font.size = Pt(font_size)
    run.bold = bold
    if color_rgb:
        run.font.color.rgb = color_rgb

def add_bullet(doc, text, level=0, bold_prefix=None):
    p = doc.add_paragraph(style='List Bullet')
    p.paragraph_format.left_indent = Inches(0.25 + level * 0.25)
    p.paragraph_format.space_after = Pt(2)
    if bold_prefix:
        run = p.add_run(bold_prefix)
        run.bold = True
        run.font.name = 'Calibri'
        run.font.size = Pt(11)
        p.add_run(text).font.name = 'Calibri'
    else:
        run = p.add_run(text)
        run.font.name = 'Calibri'
        run.font.size = Pt(11)
    return p

def add_hr(doc):
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(4)
    p.paragraph_format.space_after  = Pt(4)
    pPr = p._p.get_or_add_pPr()
    pBdr = OxmlElement('w:pBdr')
    bottom = OxmlElement('w:bottom')
    bottom.set(qn('w:val'), 'single')
    bottom.set(qn('w:sz'), '6')
    bottom.set(qn('w:space'), '1')
    bottom.set(qn('w:color'), '2E74B5')
    pBdr.append(bottom)
    pPr.append(pBdr)

# ══════════════════════════════════════════════════════════════
# COVER BLOCK
# ══════════════════════════════════════════════════════════════
title_p = doc.add_paragraph()
title_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
title_run = title_p.add_run('GALLBLADDER POLYPS')
title_run.font.name = 'Calibri'
title_run.font.size = Pt(22)
title_run.bold = True
title_run.font.color.rgb = RGBColor(0x1F, 0x49, 0x7D)

sub_p = doc.add_paragraph()
sub_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub_run = sub_p.add_run('Clinical Summary: Surveillance & Management Guidelines')
sub_run.font.name = 'Calibri'
sub_run.font.size = Pt(14)
sub_run.font.color.rgb = RGBColor(0x2E, 0x74, 0xB5)

meta_p = doc.add_paragraph()
meta_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
meta_run = meta_p.add_run(f'Prepared by Orris AI  |  Date: {datetime.date.today().strftime("%d %B %Y")}  |  Based on SRU 2022, European 2022, CAR 2025/2026 Guidelines')
meta_run.font.name = 'Calibri'
meta_run.font.size = Pt(9)
meta_run.font.color.rgb = RGBColor(0x80, 0x80, 0x80)
meta_run.italic = True

add_hr(doc)
doc.add_paragraph()  # spacer

# ══════════════════════════════════════════════════════════════
# SECTION 1 - DEFINITION & EPIDEMIOLOGY
# ══════════════════════════════════════════════════════════════
doc.add_heading('1. Definition & Epidemiology', level=1)

add_colored_para(doc,
    'A gallbladder (GB) polyp is any mucosal projection into the lumen of the gallbladder. '
    'Most are non-neoplastic pseudopolyps with no malignant potential, detected incidentally on ultrasound.',
    'EBF5FB', font_size=11)

doc.add_paragraph()
doc.add_heading('Prevalence', level=2)
add_bullet(doc, 'Detected in ~1-5% of adults on transabdominal ultrasound (TAUS)')
add_bullet(doc, 'Up to 5-10% in some Asian populations')
add_bullet(doc, 'Most are asymptomatic incidental findings')
add_bullet(doc, 'Cholesterol polyps account for ~60-70% of all GB polyps')

doc.add_paragraph()
doc.add_heading('Classification by Type', level=2)

# Classification table
tbl = doc.add_table(rows=1, cols=4)
tbl.style = 'Table Grid'
tbl.alignment = WD_TABLE_ALIGNMENT.CENTER

hdr_cells = tbl.rows[0].cells
headers = ['Type', 'Frequency', 'Neoplastic?', 'Malignant Potential']
hdr_colors = ['1F497D', '1F497D', '1F497D', '1F497D']
for i, (h, c) in enumerate(zip(headers, hdr_colors)):
    set_cell_bg(hdr_cells[i], c)
    set_cell_text(hdr_cells[i], h, bold=True, font_size=10,
                  color_rgb=RGBColor(0xFF, 0xFF, 0xFF), align=WD_ALIGN_PARAGRAPH.CENTER)

data = [
    ('Cholesterol polyp', '~60-70%', 'No (pseudopolyp)', 'None'),
    ('Inflammatory polyp', '~10%', 'No (pseudopolyp)', 'None'),
    ('Adenomyoma', '~25%', 'No (hyperplastic)', 'None'),
    ('Adenoma', '~4%', 'YES - true neoplasm', 'Low-moderate (size-dependent)'),
    ('Carcinoma', '~2%', 'YES - malignant', 'High'),
]
row_colors = ['FFFFFF', 'F2F2F2', 'FFFFFF', 'FFF2CC', 'FFE0E0']
for row_data, row_color in zip(data, row_colors):
    row = tbl.add_row()
    for i, val in enumerate(row_data):
        set_cell_bg(row.cells[i], row_color.replace('#',''))
        bold = (i == 0)
        set_cell_text(row.cells[i], val, bold=bold, font_size=10)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 2 - RISK FACTORS FOR MALIGNANCY
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('2. Risk Factors for Malignancy in GB Polyps', level=1)

add_colored_para(doc,
    'CLINICAL ALERT: The following risk factors increase the probability that a polyp is neoplastic (adenoma or carcinoma) rather than benign. Their presence should escalate management.',
    'FFF2CC', font_size=10.5, bold=True)

doc.add_paragraph()

# Risk factors table - 2 column
rf_tbl = doc.add_table(rows=1, cols=3)
rf_tbl.style = 'Table Grid'
rf_hdr = rf_tbl.rows[0].cells
for cell, txt in zip(rf_hdr, ['Risk Factor', 'Threshold', 'Guideline Source']):
    set_cell_bg(cell, '2E74B5')
    set_cell_text(cell, txt, bold=True, font_size=10,
                  color_rgb=RGBColor(0xFF, 0xFF, 0xFF), align=WD_ALIGN_PARAGRAPH.CENTER)

rf_data = [
    ('Polyp size', '≥ 10 mm (European); ≥ 15 mm (SRU 2022)', 'Both guidelines'),
    ('Morphology - sessile / broad-based', 'Sessile with focal wall thickening > 4 mm = indeterminate risk', 'SRU 2022'),
    ('Age', '> 60 years', 'European 2022 / Sleisenger'),
    ('Primary Sclerosing Cholangitis (PSC)', 'Any polyp size - risk up to 60%', 'Both guidelines'),
    ('Presence of gallstones', 'Co-existing cholelithiasis', 'Sleisenger / Yamada'),
    ('Asian ethnicity', 'Higher background GB cancer risk', 'European 2022 / Korean review'),
    ('Single polyp', 'Solitary vs. multiple (multiple = usually benign cholesterol)', 'Sleisenger'),
    ('Rapid growth', '≥ 4 mm growth within 12 months (SRU); ≥ 2 mm in 2 years (European)', 'SRU 2022 / European 2022'),
    ('Familial / genetic syndromes', 'FAP, Peutz-Jeghers syndrome', 'Yamada / Sleisenger'),
]
for i, (factor, threshold, source) in enumerate(rf_data):
    row = rf_tbl.add_row()
    bg = 'FFFFFF' if i % 2 == 0 else 'F2F2F2'
    set_cell_bg(row.cells[0], bg)
    set_cell_bg(row.cells[1], bg)
    set_cell_bg(row.cells[2], bg)
    set_cell_text(row.cells[0], factor, bold=True, font_size=10)
    set_cell_text(row.cells[1], threshold, font_size=10)
    set_cell_text(row.cells[2], source, font_size=9)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 3 - DIAGNOSTIC IMAGING
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('3. Diagnostic Imaging', level=1)

doc.add_heading('Transabdominal Ultrasound (TAUS) - First-Line', level=2)
add_bullet(doc, 'Primary imaging modality for detection and surveillance of GB polyps')
add_bullet(doc, 'Sensitivity ~80% for detection; accuracy for characterizing polyp type as low as 20%')
add_bullet(doc, 'Key feature: polyp does not move with patient position change (distinguishes from calculi); no acoustic shadowing')
add_bullet(doc, 'Up to 1/3 of "polyps" seen on US are not confirmed at cholecystectomy (false positives, especially <5 mm)')

doc.add_paragraph()
doc.add_heading('Endoscopic Ultrasound (EUS) - Second-Line', level=2)
add_bullet(doc, 'Diagnostic accuracy >90% for differentiating polyp types')
add_bullet(doc, 'EUS scoring system (size, number, shape, echogenicity, margins, Doppler flow) predicts neoplastic potential')
add_bullet(doc, 'Indicated when TAUS findings are indeterminate, or polyp is 6-9 mm with risk factors')

doc.add_paragraph()
doc.add_heading('Other Modalities', level=2)
add_bullet(doc, 'CEUS (Contrast-Enhanced US): detects vascularity in neoplastic polyps; emerging role')
add_bullet(doc, 'FDG-PET: anecdotal reports of predicting malignancy; not routine')
add_bullet(doc, 'CT scan: may miss polyps without contrast; limited role in characterization')

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 4 - SRU 2022 RISK STRATIFICATION
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('4. SRU 2022 Risk Stratification Algorithm', level=1)

add_colored_para(doc,
    'The 2022 Society of Radiologists in Ultrasound (SRU) consensus stratifies GB polyps by MORPHOLOGY first, then SIZE. '
    'This is now endorsed by the Canadian Association of Radiologists (CAR 2025/2026) as the preferred approach over European size-first guidelines.',
    'E2EFDA', font_size=11)

doc.add_paragraph()

# SRU stratification table
sru_tbl = doc.add_table(rows=1, cols=4)
sru_tbl.style = 'Table Grid'
sru_hdr = sru_tbl.rows[0].cells
for cell, txt in zip(sru_hdr, ['Risk Category', 'Morphology Criteria', 'Size', 'Action']):
    set_cell_bg(cell, '1F497D')
    set_cell_text(cell, txt, bold=True, font_size=10,
                  color_rgb=RGBColor(0xFF, 0xFF, 0xFF), align=WD_ALIGN_PARAGRAPH.CENTER)

sru_data = [
    ('EXTREMELY LOW RISK',
     'Pedunculated, thin-stalked ("ball-on-wall" appearance); almost certainly cholesterol/benign',
     '≤ 9 mm\n10-14 mm\n≥ 15 mm',
     'No follow-up needed\nFollow-up US at 12 months\nSurgical consultation',
     'E2EFDA'),
    ('LOW RISK',
     'Sessile or thick-stalked polyp WITHOUT adjacent focal wall thickening > 4 mm',
     '≤ 6 mm\n7-9 mm\n10-14 mm\n≥ 15 mm',
     'No follow-up needed\nFollow-up US at 12 months\nUS or surgical consultation\nSurgical consultation',
     'FFF2CC'),
    ('INDETERMINATE RISK',
     'Any polyp with adjacent focal wall thickening > 4 mm (raises concern for neoplasm)',
     '≤ 6 mm\n≥ 7 mm',
     'Follow-up US at 6 months\nSurgical consultation (always consider surgery)',
     'FFE0E0'),
]
for cat, morphology, sizes, actions, bg in sru_data:
    row = sru_tbl.add_row()
    set_cell_bg(row.cells[0], bg)
    set_cell_bg(row.cells[1], bg)
    set_cell_bg(row.cells[2], bg)
    set_cell_bg(row.cells[3], bg)
    set_cell_text(row.cells[0], cat, bold=True, font_size=10)
    set_cell_text(row.cells[1], morphology, font_size=9.5)
    set_cell_text(row.cells[2], sizes, font_size=9.5)
    set_cell_text(row.cells[3], actions, font_size=9.5)

doc.add_paragraph()
add_colored_para(doc,
    'SRU Growth Trigger: Polyp growth ≥ 4 mm within 12 months = rapid growth → surgical referral regardless of category. '
    'Growth ≤ 3 mm is within normal variation. Decrease ≥ 4 mm → consider discontinuing surveillance.',
    'FFF2CC', font_size=10.5, bold=True)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 5 - EUROPEAN 2022 GUIDELINES
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('5. European 2022 Joint Guidelines (ESGAR/EASL/EAHPBA/ESP)', level=1)

add_colored_para(doc,
    'The European guidelines are SIZE-FIRST, then risk-factor stratified. They are more conservative than SRU 2022 '
    '(lower surgery threshold at ≥10 mm). The CAR 2025 endorses SRU approach as preferred over European.',
    'EBF5FB', font_size=11)

doc.add_paragraph()
doc.add_heading('European Indications for Cholecystectomy', level=2)

eu_tbl = doc.add_table(rows=1, cols=3)
eu_tbl.style = 'Table Grid'
eu_hdr = eu_tbl.rows[0].cells
for cell, txt in zip(eu_hdr, ['Scenario', 'Polyp Size', 'Recommendation']):
    set_cell_bg(cell, '2E74B5')
    set_cell_text(cell, txt, bold=True, font_size=10,
                  color_rgb=RGBColor(0xFF, 0xFF, 0xFF), align=WD_ALIGN_PARAGRAPH.CENTER)

eu_data = [
    ('Any polyp - large', '≥ 10 mm', 'Cholecystectomy recommended'),
    ('Symptomatic polyp', '< 10 mm', 'Cholecystectomy recommended'),
    ('6-9 mm + ANY risk factor*', '6-9 mm', 'Cholecystectomy recommended'),
    ('6-9 mm - NO risk factors', '6-9 mm', 'US surveillance at 6m, 1yr, 2yr'),
    ('< 5 mm + NO risk factors', '< 5 mm', 'No surveillance needed'),
    ('< 5 mm + risk factor present', '< 5 mm', 'US at 6m, 1yr, 2yr'),
]
for i, row_data in enumerate(eu_data):
    row = eu_tbl.add_row()
    bg = 'FFFFFF' if i % 2 == 0 else 'F2F2F2'
    for j, val in enumerate(row_data):
        set_cell_bg(row.cells[j], bg)
        set_cell_text(row.cells[j], val, bold=(j==0), font_size=10)

doc.add_paragraph()
p = doc.add_paragraph()
r = p.add_run('*European risk factors for malignancy: age > 60 years | primary sclerosing cholangitis | Asian ethnicity | sessile polyp / focal GB wall thickening > 4 mm')
r.font.size = Pt(9)
r.font.italic = True
r.font.name = 'Calibri'

doc.add_paragraph()
doc.add_heading('European Growth Trigger', level=2)
add_bullet(doc, 'Growth ≥ 2 mm within the 2-year surveillance period → reassess with current size + risk factors')
add_bullet(doc, 'Multidisciplinary discussion to decide continuation of monitoring vs. cholecystectomy')

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 6 - GUIDELINE COMPARISON TABLE
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('6. Head-to-Head Guideline Comparison: SRU 2022 vs. European 2022', level=1)

comp_tbl = doc.add_table(rows=1, cols=3)
comp_tbl.style = 'Table Grid'
comp_hdr = comp_tbl.rows[0].cells
for cell, txt in zip(comp_hdr, ['Parameter', 'SRU 2022', 'European 2022']):
    set_cell_bg(cell, '1F497D')
    set_cell_text(cell, txt, bold=True, font_size=10,
                  color_rgb=RGBColor(0xFF, 0xFF, 0xFF), align=WD_ALIGN_PARAGRAPH.CENTER)

comp_data = [
    ('Primary stratifier', 'Polyp morphology, then size', 'Polyp size, then risk factors'),
    ('Surgery threshold', '≥ 15 mm (extremely low risk)\n≥ 10 mm (low risk)\n≥ 7 mm (indeterminate risk)', '≥ 10 mm universally'),
    ('6-9 mm polyp, no risk factors', 'No follow-up (extremely low risk)\nor US at 12 months (low risk)', 'US at 6m, 1yr, 2yr'),
    ('< 6 mm, no risk factors', 'No follow-up (all categories)', 'No follow-up'),
    ('Rapid growth trigger', '≥ 4 mm in 12 months → surgery', '≥ 2 mm in 2 years → reassess'),
    ('PSC patients', 'Indeterminate risk → surgery from ≥ 7 mm', 'Surgery for any polyp (high risk)'),
    ('Use of risk factors', 'Not in core algorithm (modifier only)', 'Central to algorithm'),
    ('CAR 2025 endorsement', 'PREFERRED (less aggressive, evidence-based)', 'More conservative; not preferred by CAR'),
]
for i, row_data in enumerate(comp_data):
    row = comp_tbl.add_row()
    bg = 'FFFFFF' if i % 2 == 0 else 'F2F2F2'
    for j, val in enumerate(row_data):
        set_cell_bg(row.cells[j], bg)
        set_cell_text(row.cells[j], val, bold=(j==0), font_size=10)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 7 - NATURAL HISTORY
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('7. Natural History', level=1)

add_bullet(doc, 'Mayo Clinic data: 200 patients with GB polyps followed for 15 years - <10% developed symptoms requiring surgery; NONE developed GB cancer')
add_bullet(doc, 'Annual/semi-annual US over 5 years in 109 patients with polyps < 10 mm: NO cancer developed; >88% showed no growth')
add_bullet(doc, 'Multiplicity of polyps strongly predicts benignity (cholesterol polyps mean number = 8 per series)')
add_bullet(doc, 'Single, large (>12 mm) adenomas frequently contain foci of carcinoma at resection (Japan series)')
add_bullet(doc, 'Cost-benefit (UK): surveillance of ALL GB polyps costs ~$9.7M over 20 years to save an estimated 5.4 lives/year; cost-effectiveness improves if restricted to 5-10 mm polyps')

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 8 - INDICATIONS FOR CHOLECYSTECTOMY (SUMMARY)
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('8. Indications for Cholecystectomy - Summary', level=1)

add_colored_para(doc,
    'ABSOLUTE INDICATIONS (both SRU and European agree)',
    '1F497D', font_size=11, bold=True)

p = doc.add_paragraph()
r = p.add_run('ABSOLUTE INDICATIONS (both SRU and European agree)')
r.font.bold = True
r.font.color.rgb = RGBColor(0x1F, 0x49, 0x7D)
r.font.name = 'Calibri'
r.font.size = Pt(11)

add_bullet(doc, 'Any polyp ≥ 15 mm (SRU) OR ≥ 10 mm (European) - strong suspicion of neoplasm')
add_bullet(doc, 'Symptomatic polyp (biliary pain attributable to polyp) at any size')
add_bullet(doc, 'Rapid growth: ≥ 4 mm in 12 months (SRU) / ≥ 2 mm in 2 years (European)')
add_bullet(doc, 'Indeterminate-risk polyp ≥ 7 mm on SRU criteria (focal wall thickening > 4 mm)')
add_bullet(doc, 'PSC patient with any polyp - malignant risk up to 60%')
add_bullet(doc, 'Polyp in setting of gallstones AND age > 60 years')

doc.add_paragraph()
p = doc.add_paragraph()
r = p.add_run('RELATIVE INDICATIONS (consider surgery, individualize)')
r.font.bold = True
r.font.color.rgb = RGBColor(0xC5, 0x50, 0x00)
r.font.name = 'Calibri'
r.font.size = Pt(11)

add_bullet(doc, 'Polyp 6-9 mm with one or more risk factors (European guideline)')
add_bullet(doc, 'Polyp 10-14 mm that is low-risk morphology on SRU - patient preference or evidence of growth')
add_bullet(doc, 'Solitary polyp with patient anxiety / inability to comply with surveillance')

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 9 - PATIENT APPLICATION (this case)
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('9. Application to This Patient', level=1)

add_colored_para(doc,
    'Patient: 21-year-old female | Findings: 2 gallbladder polyps, largest 3 mm | Source: Western Regional Hospital USG Report',
    'EBF5FB', font_size=11, bold=True)

doc.add_paragraph()
doc.add_heading('Assessment', level=2)
add_bullet(doc, 'Size: 3 mm - well below all thresholds for surgical concern (<5 mm)')
add_bullet(doc, 'Multiplicity: TWO polyps - strong predictor of cholesterol polyps (benign pseudopolyps)')
add_bullet(doc, 'Demographics: Young female - classic profile for cholesterol polyps (estrogen effect)')
add_bullet(doc, 'No gallstones, no free fluid, no biliary dilation on this report')

doc.add_paragraph()
doc.add_heading('Management Recommendation', level=2)

add_colored_para(doc,
    'Per SRU 2022 (CAR-endorsed preferred guideline): If morphology is pedunculated / extremely low-risk - NO surveillance ultrasound needed for polyps ≤ 9 mm.',
    'E2EFDA', font_size=10.5)
doc.add_paragraph()
add_colored_para(doc,
    'Per European 2022: Polyps < 5 mm with NO risk factors - NO follow-up required.',
    'E2EFDA', font_size=10.5)

doc.add_paragraph()

add_bullet(doc, 'ACTION: Reassure patient - this is almost certainly a benign cholesterol polyp')
add_bullet(doc, 'No immediate intervention or surgery indicated')
add_bullet(doc, 'If any risk factors present (PSC, age >60, Asian): US at 6 months, 1 year, 2 years')
add_bullet(doc, 'If polyp grows ≥ 4 mm or becomes symptomatic: reassess and consider cholecystectomy')
add_bullet(doc, 'Address modifiable risk: dietary advice regarding fat/cholesterol intake, weight management if applicable')

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 10 - REFERENCES
# ══════════════════════════════════════════════════════════════
add_hr(doc)
doc.add_heading('10. Key References', level=1)

refs = [
    'Sleisenger and Fordtran\'s Gastrointestinal and Liver Disease, 11th ed. Chapter 67: Cholesterolosis & Gallbladder Polyps.',
    'Yamada\'s Textbook of Gastroenterology, 7th ed. Chapter 84: Benign Tumors of the Gallbladder.',
    'Fung CI, Kamaya A, et al. Recommendations for the Management of Incidentally Detected Gallbladder Polyps: Update of the 2020 CAR Recommendations. Can Assoc Radiol J. 2026. PMID: 40483673.',
    'Son JH. Recent Updates on Management and Follow-up of Gallbladder Polyps. Korean J Gastroenterol. 2023. PMID: 37226819.',
    'Society of Radiologists in Ultrasound (SRU) Consensus Conference Recommendations for Incidental Gallbladder Polyp Management. Radiology. November 2022.',
    'European (ESGAR/EASL/EAHPBA/ESP) Joint Guidelines on GB Polyp Management. 2022.',
    'Fischer\'s Mastery of Surgery, 8th ed. Chapter: Gallbladder Polyps.',
]
for i, ref in enumerate(refs, 1):
    p = doc.add_paragraph()
    p.paragraph_format.left_indent = Inches(0.25)
    p.paragraph_format.first_line_indent = Inches(-0.25)
    p.paragraph_format.space_after = Pt(4)
    r = p.add_run(f'{i}. {ref}')
    r.font.name = 'Calibri'
    r.font.size = Pt(9.5)

# ══════════════════════════════════════════════════════════════
# FOOTER
# ══════════════════════════════════════════════════════════════
add_hr(doc)
footer_p = doc.add_paragraph()
footer_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
fr = footer_p.add_run('This document is a clinical summary prepared for educational purposes. Clinical decisions should be individualized based on patient presentation, local guidelines, and specialist consultation.')
fr.font.name = 'Calibri'
fr.font.size = Pt(8.5)
fr.font.italic = True
fr.font.color.rgb = RGBColor(0x80, 0x80, 0x80)

# Save
out_path = '/tmp/workspace/gb-polyp/GB_Polyp_Surveillance_Management.docx'
doc.save(out_path)
print(f'Saved: {out_path}')