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pres.title = "Examination of Acute Abdomen";
pres.author = "General Surgery PG Clinic";

// ─────────────────────────────────────────────
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// Table stripe:       EAF0FB
// ─────────────────────────────────────────────

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// ═══════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════
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// ═══════════════════════════════════════════
// SLIDE 2 — OUTLINE
// ═══════════════════════════════════════════
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    ["05", "Abdominal Examination — Inspection"],
    ["06", "Palpation — Tenderness, Guarding & Rigidity"],
    ["07", "Percussion & Auscultation"],
    ["08", "Eponymous Signs (Table)"],
    ["09", "Rectal, Genital & Pelvic Examination"],
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// ═══════════════════════════════════════════
// SLIDE 3 — DEFINITION & RELEVANCE
// ═══════════════════════════════════════════
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  slideHeader(s, "DEFINITION & SURGICAL RELEVANCE", "Sabiston Textbook of Surgery 21e, Chapter 85");

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    "Diagnosis is primarily clinical — history and examination remain paramount",
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// ═══════════════════════════════════════════
// SLIDE 4 — CAUSES & CLASSIFICATION
// ═══════════════════════════════════════════
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  slideHeader(s, "CAUSES & CLASSIFICATION OF ACUTE ABDOMEN", "Bailey & Love 28e");

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// ═══════════════════════════════════════════
// SLIDE 5 — HISTORY: SOCRATES PAIN ANALYSIS
// ═══════════════════════════════════════════
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    ["C", "Character", "Colicky (obstruction, colic) vs constant (inflammation, peritonitis)"],
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    ["A", "Associations", "Fever, vomiting (time relative to pain), bowel habit, urinary sx, last menstrual period"],
    ["T", "Timing", "Duration; continuous vs intermittent; worsening or improving; any similar past episodes"],
    ["E", "Exacerbating/ Relieving", "Peritonitis: worse on movement; colic: cannot lie still; pancreatitis: worse supine, better sitting forward"],
    ["S", "Severity", "1-10 scale; able to walk? Change in severity over time; evolution important"],
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// ═══════════════════════════════════════════
// SLIDE 6 — ASSOCIATED HISTORY & SYSTEMIC REVIEW
// ═══════════════════════════════════════════
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        "Vomiting: before pain → obstruction; after → appendicitis/peritonitis",
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        "Absolute constipation (flatus + faeces) → complete obstruction",
        "Diarrhoea → gastroenteritis, ischaemic colitis",
        "Jaundice + RUQ pain → biliary pathology",
        "Last bowel movement / normal stool pattern",
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        "Fever + rigors: infective/inflammatory; sweating: vascular event",
        "Weight loss: malignancy, Crohn's, TB",
        "Previous abdominal surgery: adhesions, anastomotic leak",
        "Vascular disease / smoking: AAA, mesenteric ischaemia",
        "Atrial fibrillation: mesenteric embolism",
        "Medications: NSAIDs (PU), steroids (blunted signs), anticoagulants",
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    {
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        "Last menstrual period — exclude ectopic pregnancy",
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        "Vaginal discharge → PID",
        "Dyspareunia → endometriosis/PID",
        "Sudden severe pain → ovarian torsion / ruptured cyst",
        "Contraception history",
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// ═══════════════════════════════════════════
// SLIDE 7 — SECTION BREAK: PHYSICAL EXAMINATION
// ═══════════════════════════════════════════
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  sectionSlide(s, "02", "PHYSICAL EXAMINATION", "Systemic Assessment → Abdominal Examination");
}

// ═══════════════════════════════════════════
// SLIDE 8 — GENERAL / SYSTEMIC EXAMINATION
// ═══════════════════════════════════════════
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  slideHeader(s, "GENERAL EXAMINATION — BEFORE TOUCHING THE ABDOMEN", "Sabiston 21e | Bailey & Love 28e");

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    ["BP", "Hypotension: haemorrhagic/septic shock; Postural drop: volume depletion"],
    ["Temperature", "Fever (>38°C): inflammatory/infective. Hypothermia: severe sepsis"],
    ["Respiratory rate", "Tachypnoea: sepsis, diaphragmatic irritation, metabolic acidosis"],
    ["SpO2", "Hypoxaemia: aspiration, thoracic sepsis, ARDS in severe sepsis"],
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    "Posture: still (peritonitis) vs. writhing (colic — cannot get comfortable)",
    "Jaundice, pallor, cyanosis — examine conjunctivae and mucous membranes",
    "Dehydration: dry tongue, reduced skin turgor, sunken eyes",
    "Lymphadenopathy: left supraclavicular (Virchow's / Troisier sign → gastric CA)",
    "Hands: clubbing (IBD, cirrhosis), leukonychia (hypoalbuminaemia), Dupuytren's (alcoholic liver disease), liver flap (hepatic encephalopathy)",
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  addFooter(s, "Sabiston Textbook of Surgery 21e | Bailey & Love's Short Practice of Surgery 28e");
}

// ═══════════════════════════════════════════
// SLIDE 9 — ABDOMINAL EXAMINATION: INSPECTION
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "ABDOMINAL EXAMINATION — INSPECTION", "Sleisenger & Fordtran 11e | Sabiston 21e");

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    { cat: "SKIN CHANGES", color: "1A6B8A", items: ["Cullen sign — periumbilical bruising (haemoperitoneum, acute pancreatitis)", "Grey Turner sign — flank bruising (retroperitoneal haemorrhage, pancreatitis)", "Ranshoff sign — yellow umbilical discolouration (ruptured CBD)", "Caput medusae — dilated periumbilical veins (portal hypertension)"] },
    { cat: "SCARS & HERNIAE", color: "7D3C98", items: ["All scars mapped — previous surgery, adhesion risk, organ anatomy altered", "Midline scars → risk of incisional hernia + adhesive SBO", "Stoma sites, drain sites, laparoscopic port scars", "Visible peristalsis — ladder pattern in late SBO"] },
    { cat: "MOVEMENTS", color: "1E8449", items: ["Reduced/absent abdominal movement with respiration → peritonitis", "Visible pulsation epigastrium → AAA (beware pulsatile liver)", "Ask patient to cough — cough tenderness localises peritonism before palpation"] },
  ];

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  addFooter(s, "Sleisenger & Fordtran's GI and Liver Disease 11e | Sabiston Textbook of Surgery 21e");
}

// ═══════════════════════════════════════════
// SLIDE 10 — AUSCULTATION (before palpation — order matters)
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "AUSCULTATION — BEFORE PALPATION", "Sleisenger & Fordtran 11e");

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  const auscData = [
    { label: "NORMAL", color: "1E8449", desc: "Low-pitched gurgles, 5-34/min. Variable — do not over-interpret." },
    { label: "ABSENT", color: "C0392B", desc: "Listen ≥2 min in >1 quadrant before declaring 'silent abdomen.' Suggests ileus (paralytic or from peritonitis) or late obstruction with ischaemia." },
    { label: "INCREASED / TINKLING", color: "1A6B8A", desc: "High-pitched tinkling sounds: early/mid mechanical bowel obstruction. 'Borborygmi' = loud rushing sounds of active peristalsis above obstruction." },
    { label: "SUCCUSSION SPLASH", color: "7D3C98", desc: "Audible splash on shaking the abdomen >3 hours post-meal → gastric outlet obstruction (pyloric stenosis, gastric CA) or gastroparesis." },
    { label: "VASCULAR BRUIT", color: "E8671B", desc: "Epigastric bruit → renal artery stenosis or celiac artery stenosis. Aortic bruit → AAA or aorto-iliac occlusive disease. Low sensitivity and specificity; interpret with clinical context." },
    { label: "STETHOSCOPE PALPATION", color: "4A235A", desc: "Begin palpating gently with the stethoscope head while auscultating — watch facial expression. Allows assessment of tenderness before formal palpation (Sleisenger & Fordtran)." },
  ];

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  addFooter(s, "Sleisenger & Fordtran's GI and Liver Disease 11e");
}

// ═══════════════════════════════════════════
// SLIDE 11 — PALPATION
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "PALPATION — TECHNIQUE & FINDINGS", "Sabiston 21e | Sleisenger & Fordtran 11e");

  // Technique box
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  s.addText("TECHNIQUE", { x: 0.25, y: 1.07, w: 4.4, h: 0.32, fontSize: 12, bold: true, color: WHITE, charSpacing: 2, fontFace: "Calibri", valign: "middle", margin: 0 });
  const technique = [
    "Warm hands — cold hands cause voluntary guarding",
    "Start away from site of pain — always palpate the painful area LAST",
    "Begin with light palpation (superficial structures, tenderness)",
    "Proceed to deep palpation (organs, masses, depth of tenderness)",
    "Watch the patient's face throughout — not just the abdomen",
    "Ask patient to breathe through the mouth — relaxes abdominal wall",
    "Palpate all 9 regions systematically: epigastric, umbilical, hypogastric, both hypochondria, both lumbar, both iliac fossae",
    "Rigid abdomen = surgical emergency — do not waste time on formal exam; proceed to theatre",
  ];
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  });

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  s.addText("KEY PALPATION FINDINGS", { x: 5.0, y: 1.07, w: 4.75, h: 0.32, fontSize: 12, bold: true, color: WHITE, charSpacing: 1, fontFace: "Calibri", valign: "middle", margin: 0 });
  const findings = [
    ["Tenderness", "Localised (organ specific) vs. diffuse (generalised peritonitis)"],
    ["Voluntary guarding", "Patient voluntarily tenses abdomen in anticipation of pain — overcome by distraction"],
    ["Involuntary guarding", "Reflex muscle spasm — cannot be overcome — true peritoneal sign"],
    ["Rigidity", "'Board-like rigidity' — extreme involuntary guarding; classic for perforated viscus"],
    ["Rebound tenderness (Blumberg)", "Pain on sudden release of pressure > pain on application → parietal peritoneal inflammation"],
    ["Mass", "Character: site, size, shape, surface, consistency, edge, mobility, pulsatility, tenderness"],
    ["Organomegaly", "Tender hepatomegaly (hepatitis, CHF); Murphy's point tenderness (cholecystitis)"],
    ["Hyperalgesia", "Cutaneous hyperaesthesia overlying inflamed viscus (e.g., RIF in appendicitis)"],
  ];
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  });
  addFooter(s, "Sabiston Textbook of Surgery 21e | Sleisenger & Fordtran's GI and Liver Disease 11e");
}

// ═══════════════════════════════════════════
// SLIDE 12 — PERCUSSION
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "PERCUSSION", "Bailey & Love 28e | Sabiston 21e");

  const items = [
    { title: "PERCUSSION TENDERNESS", color: RED, body: "Gentle percussion over the abdomen can detect peritonism with less discomfort than deep palpation. Pain on finger-percussion replaces the traditional 'rebound' test and avoids causing unnecessary pain (Sleisenger & Fordtran — rebound may be elicited by jarring the bed or finger percussion)." },
    { title: "TYMPANY", color: "1A6B8A", body: "Generalised tympany → gaseous distension (obstruction, paralytic ileus). Tympany over normally dull areas (e.g., liver) → free gas under right diaphragm (perforation). Loss of liver dullness → pneumoperitoneum." },
    { title: "DULLNESS & SHIFTING DULLNESS", color: "7D3C98", body: "Dullness in flanks with central resonance → ascites (confirm with shifting dullness and fluid thrill). Fixed dullness → solid mass, haematoma. Balance sign: dull LUQ with shifting dullness in right flank → splenic rupture/haematoma." },
    { title: "HEPATIC & SPLENIC DULLNESS", color: "1E8449", body: "Upper border of liver dullness at 5th ICS (MCL). Percussion determines size of liver. Loss of splenic dullness (Traube's space) → splenomegaly." },
    { title: "RENAL ANGLE TENDERNESS", color: "C0392B", body: "Costovertebral angle tenderness (Murphy's punch sign) — fist percussion over the renal angles → pyelonephritis, perinephric abscess, ureteric obstruction." },
    { title: "SUPRAPUBIC DULLNESS", color: "4A235A", body: "Dullness in the suprapubic region → distended urinary bladder (retention), pelvic mass, gravid uterus. Always percuss before inserting a catheter." },
  ];

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  addFooter(s, "Bailey & Love's Short Practice of Surgery 28e | Sabiston Textbook of Surgery 21e");
}

// ═══════════════════════════════════════════
// SLIDE 13 — EPONYMOUS SIGNS (TABLE)
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "EPONYMOUS SIGNS IN ACUTE ABDOMEN", "Sabiston Textbook of Surgery 21e — Table 85.4");

  const rows = [
    ["Murphy's Sign", "Respiratory arrest on deep RUQ palpation during inspiration", "Acute cholecystitis"],
    ["Rovsing's Sign", "RIF pain when palpating LIF", "Acute appendicitis"],
    ["Psoas Sign", "Pain on extension/elevation of right leg against resistance", "Retrocaecal appendicitis"],
    ["Obturator Sign", "RIF pain on passive internal rotation of flexed right hip", "Pelvic/pelvic appendicitis"],
    ["Blumberg's Sign", "Pain on sudden release of pressure (rebound tenderness)", "Peritoneal inflammation"],
    ["Cullen's Sign", "Periumbilical bruising", "Haemoperitoneum, pancreatitis"],
    ["Grey Turner's Sign", "Flank bruising (ribs to iliac crest)", "Retroperitoneal haemorrhage, pancreatitis"],
    ["Balance Sign", "Dull LUQ + shifting dullness right flank", "Splenic rupture / haematoma"],
    ["Carnett's Sign", "Pain persists/increases when abdominal muscles tensed", "Abdominal wall source of pain"],
    ["Chandelier Sign", "Extreme pain on cervical motion", "Pelvic inflammatory disease"],
    ["Howship-Romberg", "Inner thigh pain on internal hip rotation", "Obturator hernia"],
    ["Ranshoff Sign", "Yellow periumbilical discolouration", "Ruptured common bile duct"],
  ];

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  addFooter(s, "Sabiston Textbook of Surgery 21e — Table 85.4 (Eponymous Abdominal Examination Signs and Manoeuvres)");
}

// ═══════════════════════════════════════════
// SLIDE 14 — RECTAL, PELVIC & GENITAL EXAM
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "RECTAL, PELVIC & GENITAL EXAMINATION", "Sleisenger & Fordtran 11e | Sabiston 21e");

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  s.addText('"The pelvic organs and external genitalia should be examined in every patient with acute abdominal pain."  — Sleisenger & Fordtran', {
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    fontSize: 11.5, italic: true, color: GOLD, fontFace: "Calibri", valign: "middle", margin: 0
  });

  const examSections = [
    {
      heading: "DIGITAL RECTAL EXAMINATION (DRE)", color: "C0392B",
      items: [
        "Inspect perianal region: fissures, fistulae, haemorrhoids, skin tags",
        "Sphincter tone; any masses or irregularity",
        "High anterior tenderness → pelvic peritonism (pelvic appendicitis, PID, Douglas abscess)",
        "Boggy tender mass anteriorly → pelvic abscess / haematoma (ruptured ectopic)",
        "Bone-hard irregular prostate → carcinoma",
        "Blood on glove: tumour, intussusception, ischaemic colitis",
        "Empty rectum in obstruction; impacted faeces in pseudo-obstruction",
        "Ballooning of rectum → rectal carcinoma or late obstruction with dilatation above",
      ]
    },
    {
      heading: "PELVIC EXAMINATION (BIMANUAL — WOMEN)", color: "7D3C98",
      items: [
        "Cervical excitation / motion tenderness → pelvic peritonism (PID, ectopic)",
        "Chandelier sign — extreme pain on cervical movement → PID",
        "Adnexal tenderness/mass → ovarian torsion, ectopic pregnancy, ovarian cyst",
        "Vaginal discharge → PID, STI",
        "Bulging tender Douglas pouch → haemoperitoneum, pelvic abscess",
        "Uterine size, shape, mobility",
        "Always perform in women with acute lower abdominal pain",
        "Mandatory: urine β-hCG in all women of reproductive age",
      ]
    },
    {
      heading: "GENITAL EXAMINATION (MEN)", color: "1A6B8A",
      items: [
        "Examine scrotum — exclude testicular torsion (can present as abdominal pain)",
        "Tender testis with absent cremasteric reflex → torsion (surgical emergency)",
        "Scrotal swelling with cough impulse → indirect inguinal hernia",
        "Hydrocoele, epididymo-orchitis",
        "Examine groins bilaterally for inguinal hernia",
        "Tender inguinal hernia with no cough impulse → incarcerated/strangulated",
        "Urethral discharge → urethritis / STI",
        "Femoral herniae — always check femoral canal (esp. elderly women)",
      ]
    },
  ];

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  });
  addFooter(s, "Sleisenger & Fordtran's GI and Liver Disease 11e | Sabiston Textbook of Surgery 21e");
}

// ═══════════════════════════════════════════
// SLIDE 15 — INVESTIGATIONS
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "INVESTIGATIONS IN ACUTE ABDOMEN", "Sleisenger & Fordtran 11e | Sabiston 21e");

  const inv = [
    {
      heading: "BEDSIDE", color: "1A6B8A",
      items: ["Urine dipstick (UTI, haematuria, glycosuria, β-hCG)", "Blood glucose (DKA)", "ECG (inferior MI presenting as epigastric pain)", "PR bleed on glove"]
    },
    {
      heading: "BLOODS", color: NAVY,
      items: ["FBC: WBC (infection/perforation), Hb (bleeding), platelets", "CRP/ESR: inflammation, sepsis", "U&E + creatinine: renal function, fluid/electrolytes", "Amylase/lipase: pancreatitis (lipase >3x ULN = diagnostic)", "LFTs + bilirubin: biliary/hepatic pathology", "Coagulation: DIC, liver disease", "Lactate: tissue hypoperfusion, ischaemia", "Group & crossmatch if surgical intervention likely", "β-hCG: all women of reproductive age (mandatory)"]
    },
    {
      heading: "RADIOLOGY", color: "7D3C98",
      items: ["Erect CXR: free gas under diaphragm (perforated viscus) — 75% sensitivity", "Supine AXR: dilated bowel loops (obstruction), valvulae conniventes (SBO) vs haustra (LBO), air-fluid levels, calcified gallstones/AAA", "USG abdomen: first-line for gallbladder, renal, gynaecological pathology — portable, no radiation", "CECT abdomen/pelvis (GOLD STANDARD): sensitivity 94%, specificity 95% for appendicitis (Sleisenger & Fordtran); defines most causes of acute abdomen; essential before surgery in unclear cases", "MRI: preferred in pregnancy; biliary pathology (MRCP)"]
    },
    {
      heading: "SPECIAL / INVASIVE", color: "C0392B",
      items: ["Diagnostic laparoscopy: when imaging inconclusive; allows simultaneous therapy", "Diagnostic peritoneal lavage (DPL): largely superseded by CECT in blunt trauma", "Endoscopy (ERCP): CBD stones, cholangitis — simultaneous therapeutic", "Paracentesis: ascites for cytology, culture, SAAG"]
    },
  ];

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  });
  addFooter(s, "Sleisenger & Fordtran's GI and Liver Disease 11e | Sabiston Textbook of Surgery 21e");
}

// ═══════════════════════════════════════════
// SLIDE 16 — CLINICAL DECISION MAKING ALGORITHM
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "CLINICAL DECISION-MAKING IN ACUTE ABDOMEN", "Sabiston 21e | Bailey & Love 28e");

  // Algorithm boxes
  const steps = [
    { label: "1  HAEMODYNAMICALLY UNSTABLE?", sub: "Shock, tachycardia, hypotension, peritonitis", color: RED, action: "→ Emergency resuscitation + urgent theatre" },
    { label: "2  PERITONITIS PRESENT?", sub: "Rigidity, involuntary guarding, rebound", color: "C0392B", action: "→ Broad-spectrum antibiotics + emergency surgery" },
    { label: "3  DIAGNOSIS APPARENT CLINICALLY?", sub: "Classic presentation (appendicitis, cholecystitis, obstruction)", color: "1A6B8A", action: "→ Confirm with focused investigations, proceed to surgery/intervention" },
    { label: "4  DIAGNOSIS UNCERTAIN?", sub: "Atypical presentation, non-specific pain, elderly/immunosuppressed", color: "7D3C98", action: "→ CECT abdomen/pelvis + specialist review + serial examinations" },
    { label: "5  CONSERVATIVE MANAGEMENT?", sub: "Non-surgical cause confirmed (gastroenteritis, UTI, PID)", color: "1E8449", action: "→ Analgesia, antibiotics, observe, reassess at 4-6 hours" },
  ];

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}

// ═══════════════════════════════════════════
// SLIDE 17 — SPECIAL SITUATIONS
// ═══════════════════════════════════════════
{
  const s = pres.addSlide();
  slideHeader(s, "SPECIAL SITUATIONS — MODIFIED PRESENTATIONS", "Sabiston 21e | Bailey & Love 28e");

  const specials = [
    { cat: "ELDERLY PATIENTS", color: RED, points: ["Signs blunted — less peritonism despite perforation", "Atypical presentations common; high index of suspicion needed", "Polypharmacy (steroids, immunosuppressants) mask fever/WBC", "Vascular pathology (AAA, mesenteric ischaemia) more common", "Always examine for femoral hernia"] },
    { cat: "IMMUNOSUPPRESSED / STEROIDS", color: "7D3C98", points: ["Fever and peritonism may be absent even with perforation", "CMV colitis, neutropenic enterocolitis — consider in chemotherapy patients", "Lower threshold for CECT and surgical review", "WBC may be paradoxically low or high"] },
    { cat: "PREGNANCY", color: "1E8449", points: ["Appendix displaced superolaterally in 3rd trimester — pain not in RIF", "USG first-line; MRI preferred over CT", "Physiological WBC leukocytosis (up to 16,000) in normal pregnancy", "Right ovarian vein syndrome, round ligament pain", "Always test urine β-hCG (mandatory)"] },
    { cat: "POST-OPERATIVE PATIENT", color: "1A6B8A", points: ["Anastomotic leak (3-7 days post-op) — fever, tachycardia, ileus, peritonism", "Missed enterotomy", "Adhesive SBO (months-years later)", "Post-op haemorrhage — tachycardia + abdominal distension", "Wound dehiscence + evisceration"] },
  ];

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// ═══════════════════════════════════════════
// SLIDE 18 — SUMMARY: STRUCTURED APPROACH
// ═══════════════════════════════════════════
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  slideHeader(s, "SUMMARY — STRUCTURED APPROACH TO ACUTE ABDOMEN", "Bailey & Love 28e | Sabiston 21e");

  const steps = [
    { n: "1", title: "RESUSCITATION FIRST", desc: "Airway, Breathing, Circulation — IV access, fluids, O2 before full examination in unstable patient" },
    { n: "2", title: "HISTORY", desc: "SOCRATES for pain; associated GI, urinary, gynaecological, systemic symptoms; PMH, medications" },
    { n: "3", title: "GENERAL EXAMINATION", desc: "Vital signs, facies, posture, hands, eyes, lymphadenopathy — assess severity before touching abdomen" },
    { n: "4", title: "ABDOMINAL INSPECTION", desc: "Contour, scars, skin signs (Cullen/Grey Turner), visible peristalsis, groin, cough test" },
    { n: "5", title: "AUSCULTATE BEFORE PALPATING", desc: "Bowel sounds character; succussion splash; stethoscope palpation for tenderness" },
    { n: "6", title: "PALPATION", desc: "Light then deep; painful area last; guarding (voluntary vs. involuntary); rigidity; masses" },
    { n: "7", title: "PERCUSSION", desc: "Tenderness; liver dullness (free gas?); shifting dullness (ascites); costovertebral angle" },
    { n: "8", title: "RECTAL / PELVIC / GENITAL", desc: "Mandatory in ALL patients — pelvic peritonism, abscess, torsion, hernia" },
    { n: "9", title: "INVESTIGATIONS", desc: "Bloods (FBC, CRP, amylase, lactate, β-hCG); Erect CXR/AXR; USG; CECT (gold standard)" },
    { n: "10", title: "DECISION", desc: "Emergency surgery / urgent intervention / conservative management with serial examinations" },
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// ═══════════════════════════════════════════
// SLIDE 19 — CLOSING SLIDE
// ═══════════════════════════════════════════
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    "The diagnosis of acute abdomen is primarily clinical — history and physical examination are the cornerstone",
    "Examination must follow a structured sequence: inspect → auscultate → palpate → percuss (IAPP)",
    "Involuntary guarding and rigidity = peritonitis = surgical emergency until proven otherwise",
    "Never withhold analgesia — it does not mask signs (Cochrane evidence-based)",
    "DRE and pelvic/genital examination are MANDATORY in every acute abdomen",
    "CECT abdomen/pelvis is the gold-standard investigation (Sens 94%, Spec 95% for appendicitis)",
    "In elderly and immunosuppressed patients, classical signs are often absent — maintain high suspicion",
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// ─── Write file ───
pres.writeFile({ fileName: "/home/daytona/workspace/acute-abdomen-pptx/Examination_Acute_Abdomen.pptx" })
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