Rotation of the Gut (Midgut Rotation) - MBBS 1st Year Embryology

from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.oxml.ns import qn
from docx.oxml import OxmlElement

doc = Document()

# ── Page margins ──────────────────────────────────────────────────
from docx.shared import Cm
section = doc.sections[0]
section.top_margin    = Cm(2.2)
section.bottom_margin = Cm(2.2)
section.left_margin   = Cm(2.5)
section.right_margin  = Cm(2.5)

# ── Default Normal style ──────────────────────────────────────────
normal = doc.styles["Normal"]
normal.font.name = "Arial"
normal.font.size = Pt(11)

# Helper: set paragraph shading
def shade_para(para, fill_hex):
    pPr = para._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"), fill_hex)
    pPr.append(shd)

# Helper: add a coloured heading paragraph
def add_colour_heading(doc, text, level, rgb):
    h = doc.add_heading(text, level=level)
    for run in h.runs:
        run.font.color.rgb = RGBColor(*rgb)
        run.font.name = "Arial"
    h.runs[0].font.bold = True
    return h

# ── TITLE ─────────────────────────────────────────────────────────
title = doc.add_heading("Rotation of the Gut (Midgut Rotation)", level=0)
title.alignment = WD_ALIGN_PARAGRAPH.CENTER
for run in title.runs:
    run.font.color.rgb = RGBColor(0x1A, 0x53, 0x76)   # dark blue
    run.font.name = "Arial"
    run.font.size = Pt(18)

sub = doc.add_paragraph("MBBS 1st Year Embryology  |  Source: The Developing Human (Moore & Persaud)")
sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub.runs[0].font.color.rgb = RGBColor(0x55, 0x55, 0x55)
sub.runs[0].font.size = Pt(10)
sub.runs[0].font.italic = True

doc.add_paragraph()   # spacer

# ── SECTION 1: Overview ───────────────────────────────────────────
add_colour_heading(doc, "1. Overview", 1, (0x1A, 0x53, 0x76))

p = doc.add_paragraph(
    "The midgut is the segment of the primitive gut supplied by the superior mesenteric artery (SMA). "
    "Between weeks 6–11, it undergoes a series of herniation, rotation, and retraction events. "
    "The total rotation is 270° counterclockwise around the axis of the SMA."
)
p.paragraph_format.space_after = Pt(6)

# ── SECTION 2: Midgut Derivatives ────────────────────────────────
add_colour_heading(doc, "2. Derivatives of the Midgut", 1, (0x1A, 0x53, 0x76))

bullets = [
    "Small intestine — duodenum (distal to bile duct opening), jejunum, ileum",
    "Cecum, appendix, ascending colon, and right 1/2 to 2/3 of the transverse colon",
    "All supplied by the superior mesenteric artery",
]
for b in bullets:
    bp = doc.add_paragraph(b, style="List Bullet")
    bp.paragraph_format.space_after = Pt(2)

doc.add_paragraph()

# ── SECTION 3: Stages ─────────────────────────────────────────────
add_colour_heading(doc, "3. Stages of Midgut Rotation", 1, (0x1A, 0x53, 0x76))

stages = [
    {
        "title": "Stage 1 — Physiological Umbilical Herniation (Week 6)",
        "color": (0xC0, 0x39, 0x2B),
        "points": [
            "Rapid midgut elongation; abdominal cavity too small to contain it.",
            "A U-shaped midgut loop herniates into the proximal umbilical cord.",
            "The loop has a cranial limb (→ jejunum/ileum) and a caudal limb (→ cecum/colon).",
            "The apex communicates with the yolk sac via the omphaloenteric (vitelline) duct.",
            "If the duct persists: Meckel diverticulum (~2% population).",
        ],
    },
    {
        "title": "Stage 2 — First 90° Counterclockwise Rotation (While in cord, Week 6–10)",
        "color": (0x17, 0x7E, 0x4F),
        "points": [
            "Rotation occurs around the SMA axis while still outside the abdomen.",
            "Cranial limb moves to the RIGHT.",
            "Caudal limb moves to the LEFT.",
            "Cranial limb elongates markedly, forming loops of jejunum and ileum.",
            "Rotation is a passive process driven by differential growth.",
        ],
    },
    {
        "title": "Stage 3 — Retraction / Return to Abdomen (Week 10)",
        "color": (0x7D, 0x3C, 0x98),
        "points": [
            "Intestines return to the abdominal cavity (~10th week).",
            "Triggers: enlargement of abdominal cavity; relative decrease in liver/kidney size.",
            "Small intestine (cranial limb) returns first, passing posterior to the SMA.",
            "Small intestine occupies the central abdomen.",
        ],
    },
    {
        "title": "Stage 4 — Further 180° Counterclockwise Rotation (During Retraction)",
        "color": (0xE6, 0x7E, 0x22),
        "points": [
            "Large intestine (caudal limb) undergoes an additional 180° CCW rotation.",
            "Total rotation now = 270° counterclockwise.",
            "Cecum initially is subhepatic (below the liver) in the upper right abdomen.",
            "As ascending colon elongates, cecum descends to the right iliac fossa.",
            "Final adult position: cecum and appendix in right iliac fossa.",
        ],
    },
]

for stage in stages:
    h2 = doc.add_heading(stage["title"], level=2)
    for run in h2.runs:
        r, g, b = stage["color"]
        run.font.color.rgb = RGBColor(r, g, b)
        run.font.name = "Arial"
    for pt in stage["points"]:
        bp = doc.add_paragraph(pt, style="List Bullet")
        bp.paragraph_format.left_indent = Inches(0.25)
        bp.paragraph_format.space_after = Pt(2)
    doc.add_paragraph()

# ── SECTION 4: Summary Table ──────────────────────────────────────
add_colour_heading(doc, "4. Summary Table — Rotation at a Glance", 1, (0x1A, 0x53, 0x76))

table = doc.add_table(rows=1, cols=4)
table.style = "Table Grid"

# Header row
hdr_cells = table.rows[0].cells
headers = ["Stage", "Location", "Degrees (CCW)", "Running Total"]
for i, hdr in enumerate(headers):
    hdr_cells[i].text = hdr
    for para in hdr_cells[i].paragraphs:
        for run in para.runs:
            run.bold = True
            run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
            run.font.name = "Arial"
            run.font.size = Pt(10)
    # blue fill header
    tc = hdr_cells[i]._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"), "1A5376")
    tcPr.append(shd)

data_rows = [
    ["Initial", "In umbilical cord", "0°", "0°"],
    ["Stage 2", "Umbilical cord", "+90°", "90°"],
    ["Stage 4", "Returning to abdomen", "+180°", "270°"],
    ["Final", "In abdomen (fixed)", "—", "270° total"],
]

fills = ["FDFEFE", "EAF0F6", "FDFEFE", "D5F5E3"]

for i, row_data in enumerate(data_rows):
    row = table.add_row()
    for j, val in enumerate(row_data):
        row.cells[j].text = val
        for para in row.cells[j].paragraphs:
            for run in para.runs:
                run.font.name = "Arial"
                run.font.size = Pt(10)
        tc = row.cells[j]._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"), fills[i])
        tcPr.append(shd)

doc.add_paragraph()

# ── SECTION 5: Fixation ────────────────────────────────────────────
add_colour_heading(doc, "5. Fixation of Intestines", 1, (0x1A, 0x53, 0x76))

fixation = doc.add_paragraph(
    "After retraction, mesenteries fuse with the posterior abdominal wall, making several structures retroperitoneal:"
)
fixation.paragraph_format.space_after = Pt(4)

fixation_points = [
    "Duodenum (2nd–4th parts) — retroperitoneal (1st part remains intraperitoneal)",
    "Pancreas (head and body) — retroperitoneal",
    "Ascending colon — retroperitoneal",
    "Descending colon — retroperitoneal",
    "Jejunum and ileum — retain mesentery; remain intraperitoneal",
    "Transverse colon — intraperitoneal (has transverse mesocolon)",
    "Sigmoid colon — intraperitoneal (has sigmoid mesocolon)",
]
for pt in fixation_points:
    bp = doc.add_paragraph(pt, style="List Bullet")
    bp.paragraph_format.space_after = Pt(2)

doc.add_paragraph()

# ── SECTION 6: Congenital Anomalies ───────────────────────────────
add_colour_heading(doc, "6. Congenital Anomalies of Gut Rotation", 1, (0x1A, 0x53, 0x76))

anom_table = doc.add_table(rows=1, cols=3)
anom_table.style = "Table Grid"

anom_hdrs = ["Anomaly", "Mechanism", "Key Features"]
anom_row = anom_table.rows[0].cells
for i, h in enumerate(anom_hdrs):
    anom_row[i].text = h
    for para in anom_row[i].paragraphs:
        for run in para.runs:
            run.bold = True
            run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
            run.font.name = "Arial"
            run.font.size = Pt(10)
    tc = anom_row[i]._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"), "1A5376")
    tcPr.append(shd)

anomalies = [
    ("Non-rotation", "Only 90° rotation completed", "Small bowel on right, colon on left; Ladd's bands present"),
    ("Malrotation", "Incomplete 270° rotation/fixation", "Cecum subhepatic; risk of midgut volvulus"),
    ("Reversed rotation", "Loop rotates clockwise", "Transverse colon passes posterior to SMA"),
    ("Omphalocele", "Failure of intestines to return to abdomen", "Gut in umbilical cord; covered by peritoneum + amnion"),
    ("Midgut volvulus", "Complication of malrotation", "Bilious vomiting in neonate; surgical emergency"),
    ("Meckel diverticulum", "Persistent vitelline duct", "Rule of 2s: 2%, 2 feet from ICV, 2 inches long"),
]

anom_fills = ["FDFEFE", "EAF0F6", "FDFEFE", "EAF0F6", "FDFEFE", "EAF0F6"]

for k, (name, mech, feat) in enumerate(anomalies):
    row = anom_table.add_row()
    vals = [name, mech, feat]
    for j, val in enumerate(vals):
        row.cells[j].text = val
        for para in row.cells[j].paragraphs:
            for run in para.runs:
                run.font.name = "Arial"
                run.font.size = Pt(10)
                if j == 0:
                    run.bold = True
        tc = row.cells[j]._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"), anom_fills[k])
        tcPr.append(shd)

doc.add_paragraph()

# ── SECTION 7: High-Yield Exam Points ────────────────────────────
add_colour_heading(doc, "7. High-Yield Exam Points", 1, (0x1A, 0x53, 0x76))

exam_box = doc.add_paragraph()
shade_para(exam_box, "EBF5FB")
exam_box.paragraph_format.space_after = Pt(2)
exam_box.paragraph_format.space_before = Pt(2)

high_yield = [
    "Total rotation = 270° counterclockwise around the SMA axis.",
    "Herniation begins at week 6; retraction at week 10.",
    "Cranial limb → small intestine; caudal limb → cecum, appendix, ascending colon, proximal transverse colon.",
    "First 90° occurs while in the umbilical cord.",
    "Remaining 180° occurs as the intestines return to the abdomen.",
    "Retroperitoneal structures: D2–D4 duodenum, pancreas, ascending colon, descending colon.",
    "Meckel diverticulum = Rule of 2s: 2% population, 2 feet from ICV, 2 inches long, 2 types of ectopic tissue.",
    "Malrotation → midgut volvulus = surgical emergency (bilious vomiting in neonate).",
    "Non-rotation = only 90° completed → small bowel on right, colon on left.",
    "64% of people have a retrocecal appendix.",
]

for pt in high_yield:
    bp = doc.add_paragraph(f"✓  {pt}", style="List Bullet")
    bp.paragraph_format.space_after = Pt(3)
    for run in bp.runs:
        run.font.name = "Arial"
        run.font.size = Pt(11)

doc.add_paragraph()

# ── Footer reference ──────────────────────────────────────────────
ref_para = doc.add_paragraph(
    "Reference: The Developing Human — Clinically Oriented Embryology, Moore & Persaud | "
    "Sabiston Textbook of Surgery, 21e"
)
ref_para.alignment = WD_ALIGN_PARAGRAPH.CENTER
ref_para.runs[0].font.size = Pt(9)
ref_para.runs[0].font.italic = True
ref_para.runs[0].font.color.rgb = RGBColor(0x77, 0x77, 0x77)

# ── Save ──────────────────────────────────────────────────────────
out = "/tmp/workspace/midgut-rotation/Midgut_Rotation_Summary.docx"
doc.save(out)
print(f"Saved: {out}")