The 9 Abdominal Regions (Quadrants) — Anatomy, Pathology, Pharmacology, Surgery & Medicine

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, Image, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
import os

OUTPUT = '/home/daytona/workspace/9-abdominal-regions/9_Abdominal_Regions.pdf'
IMG_GRAY = '/home/daytona/workspace/9-abdominal-regions/gray_regions.png'
IMG_BAILEY = '/home/daytona/workspace/9-abdominal-regions/bailey_pain.png'

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm, leftMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

W, H = A4
styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle('Title', parent=styles['Title'],
    fontSize=22, textColor=colors.HexColor('#1a237e'),
    spaceAfter=6, alignment=TA_CENTER, fontName='Helvetica-Bold')

subtitle_style = ParagraphStyle('Subtitle', parent=styles['Normal'],
    fontSize=11, textColor=colors.HexColor('#37474f'),
    spaceAfter=12, alignment=TA_CENTER)

h1_style = ParagraphStyle('H1', parent=styles['Heading1'],
    fontSize=16, textColor=colors.white,
    spaceBefore=14, spaceAfter=6,
    fontName='Helvetica-Bold', backColor=colors.HexColor('#1a237e'),
    leftIndent=-0.5*cm, rightIndent=-0.5*cm,
    borderPad=6)

h2_style = ParagraphStyle('H2', parent=styles['Heading2'],
    fontSize=12, textColor=colors.HexColor('#1a237e'),
    spaceBefore=10, spaceAfter=4,
    fontName='Helvetica-Bold',
    borderPad=3)

h3_style = ParagraphStyle('H3', parent=styles['Heading3'],
    fontSize=10, textColor=colors.HexColor('#b71c1c'),
    spaceBefore=6, spaceAfter=3,
    fontName='Helvetica-Bold')

body_style = ParagraphStyle('Body', parent=styles['Normal'],
    fontSize=9.5, leading=14,
    spaceAfter=4, alignment=TA_JUSTIFY,
    fontName='Helvetica')

bullet_style = ParagraphStyle('Bullet', parent=styles['Normal'],
    fontSize=9.5, leading=13, leftIndent=14,
    bulletIndent=4, spaceAfter=2,
    fontName='Helvetica')

caption_style = ParagraphStyle('Caption', parent=styles['Normal'],
    fontSize=8, textColor=colors.grey,
    alignment=TA_CENTER, spaceAfter=6)

def h1(text):
    return Paragraph(f'  {text}', h1_style)

def h2(text):
    return Paragraph(text, h2_style)

def h3(text):
    return Paragraph(text, h3_style)

def body(text):
    return Paragraph(text, body_style)

def bullet(text):
    return Paragraph(f'• {text}', bullet_style)

def sp(n=1):
    return Spacer(1, n*0.3*cm)

def hr():
    return HRFlowable(width='100%', thickness=0.5, color=colors.HexColor('#b0bec5'), spaceAfter=4)

story = []

# ── COVER PAGE ─────────────────────────────────────────────────────────────────
story.append(Spacer(1, 3*cm))
story.append(Paragraph('The 9 Abdominal Regions', title_style))
story.append(sp(0.5))
story.append(Paragraph('Anatomy · Pathology · Pharmacology (POM) · Surgery · Medicine', subtitle_style))
story.append(sp(0.5))
story.append(HRFlowable(width='80%', thickness=2, color=colors.HexColor('#1a237e'), spaceAfter=10))
story.append(sp(1))

# Add both images side by side on cover
if os.path.exists(IMG_GRAY) and os.path.exists(IMG_BAILEY):
    img1 = Image(IMG_GRAY, width=7.5*cm, height=9*cm)
    img2 = Image(IMG_BAILEY, width=7.5*cm, height=9*cm)
    cover_table = Table([[img1, img2]], colWidths=[8*cm, 8*cm])
    cover_table.setStyle(TableStyle([
        ('ALIGN', (0,0), (-1,-1), 'CENTER'),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ]))
    story.append(cover_table)
    story.append(sp(0.3))
    story.append(Paragraph('Left: Gray\'s Anatomy for Students — Nine-region pattern  |  Right: Bailey & Love — Nine sites of abdominal pain', caption_style))

story.append(Spacer(1, 2*cm))
story.append(Paragraph('Sources: Gray\'s Anatomy for Students · Bailey & Love\'s Short Practice of Surgery ·\nTintinalli\'s Emergency Medicine · Rosen\'s Emergency Medicine ·\nSleisenger & Fordtran\'s GI & Liver Disease · Yamada\'s Textbook of Gastroenterology', subtitle_style))
story.append(PageBreak())

# ── INTRO ──────────────────────────────────────────────────────────────────────
story.append(h1('Anatomical Basis of the Nine-Region Division'))
story.append(sp())
story.append(body(
    'The abdomen is divided into <b>9 regions</b> by <b>4 planes</b>:'
))
story.append(bullet('<b>Subcostal plane (superior horizontal)</b>: immediately inferior to costal margins at lower border of costal cartilage of rib X, passing posteriorly through vertebra LIII.'))
story.append(bullet('<b>Intertubercular plane (inferior horizontal)</b>: connecting tubercles of iliac crests (~5 cm posterior to ASIS), passing through upper body of vertebra LV.'))
story.append(bullet('<b>Two midclavicular (vertical) planes</b>: from midpoint of clavicles inferiorly to midpoint between ASIS and pubic symphysis.'))
story.append(sp())
story.append(body(
    'These four planes create nine regions: <b>Right Hypochondrium</b>, <b>Epigastric</b>, <b>Left Hypochondrium</b> (superior row); '
    '<b>Right Flank</b>, <b>Umbilical</b>, <b>Left Flank</b> (middle row); '
    '<b>Right Iliac Fossa</b>, <b>Pubic/Hypogastric</b>, <b>Left Iliac Fossa</b> (inferior row).'
))
story.append(sp(2))

# ─── REGIONS DATA ─────────────────────────────────────────────────────────────
regions = [
    {
        'num': '1',
        'name': 'Right Hypochondrium (Right Subcostal)',
        'anatomy': [
            'Liver (right lobe — primary location)',
            'Gallbladder',
            'Hepatic flexure of colon',
            'Right kidney (upper pole) and right adrenal gland',
            'Part of duodenum (D1)',
        ],
        'pathology': [
            '<b>Hepatitis</b> (viral, alcoholic, autoimmune) — tender hepatomegaly',
            '<b>Acute/Chronic Cholecystitis</b> — Murphy\'s sign positive',
            '<b>Cholelithiasis</b> — biliary colic',
            '<b>Liver abscess</b>, Hepatocellular carcinoma (HCC)',
            '<b>Subphrenic abscess</b>',
        ],
        'pharmacology': [
            '<b>Ursodeoxycholic acid</b> — dissolution of cholesterol gallstones; primary biliary cholangitis',
            '<b>Antivirals</b>: tenofovir/entecavir (HBV); sofosbuvir/ledipasvir (HCV)',
            '<b>Antispasmodics</b> (hyoscine butylbromide) for biliary colic pain relief',
            'Avoid <b>hepatotoxic drugs</b> (paracetamol overdose, isoniazid, statins) — monitor LFTs',
        ],
        'surgery': [
            '<b>Laparoscopic cholecystectomy</b> — gold standard for symptomatic gallstones',
            '<b>Open cholecystectomy</b> via Kocher\'s (right subcostal) incision for complicated cases',
            '<b>ERCP + sphincterotomy</b> for choledocholithiasis',
            '<b>Liver resection (hepatectomy)</b> for HCC or colorectal liver metastases',
        ],
        'medicine': [
            '<b>Murphy\'s sign</b>: RUQ tenderness on deep inspiration — pathognomonic for cholecystitis',
            '<b>Charcot\'s triad</b>: RUQ pain + jaundice + fever = ascending cholangitis',
            '<b>Courvoisier\'s law</b>: palpable gallbladder + painless jaundice = malignancy (not stones)',
            'US abdomen = first-line imaging; MRCP for bile duct evaluation',
        ],
    },
    {
        'num': '2',
        'name': 'Epigastric Region',
        'anatomy': [
            'Stomach and duodenum (D1, D2)',
            'Liver (left lobe), lesser omentum',
            'Pancreas (head and body)',
            'Abdominal aorta (coeliac axis origin), inferior vena cava',
        ],
        'pathology': [
            '<b>Peptic ulcer disease</b> (gastric/duodenal) — burning pain; worse/better with food',
            '<b>Acute pancreatitis</b> — severe epigastric pain radiating to the back',
            '<b>Gastritis</b>, GORD',
            '<b>Abdominal aortic aneurysm (AAA)</b> — pulsatile epigastric mass',
            '<b>Gastric cancer</b>',
        ],
        'pharmacology': [
            '<b>PPIs</b> (omeprazole, lansoprazole) — first-line for GORD, peptic ulcer, H. pylori eradication',
            '<b>H. pylori triple therapy</b>: PPI + clarithromycin + amoxicillin (7–14 days)',
            '<b>H2-blockers</b> (famotidine) — second-line acid suppression',
            '<b>Octreotide</b> — reduces pancreatic secretions in acute pancreatitis',
            '<b>IV morphine</b> for severe pancreatitis pain; prokinetics (metoclopramide) for gastroparesis',
        ],
        'surgery': [
            '<b>Whipple\'s procedure</b> (pancreaticoduodenectomy) for pancreatic head/periampullary cancer',
            '<b>Billroth I/II gastrectomy</b> or <b>Roux-en-Y</b> for gastric cancer',
            '<b>Endoscopic hemostasis</b> for bleeding peptic ulcer (adrenaline injection, clips)',
            '<b>AAA repair</b> — open (midline laparotomy) or EVAR (endovascular)',
        ],
        'medicine': [
            '<b>Ranson\'s/Glasgow score</b> for pancreatitis severity assessment',
            '<b>Cullen\'s sign</b> (periumbilical bruising) + <b>Grey Turner\'s sign</b> (flank bruising) = haemorrhagic pancreatitis',
            '<b>H. pylori testing</b>: urea breath test, stool antigen, CLO test on biopsy',
            'Epigastric pain + ECG changes → rule out <b>inferior MI</b> (referred via phrenic nerve)',
        ],
    },
    {
        'num': '3',
        'name': 'Left Hypochondrium (Left Subcostal)',
        'anatomy': [
            'Spleen',
            'Tail of pancreas',
            'Stomach (fundus and body)',
            'Left kidney (upper pole) and left adrenal gland',
            'Splenic flexure of colon',
        ],
        'pathology': [
            '<b>Splenomegaly</b> (malaria, CML, portal hypertension, EBV, lymphoma)',
            '<b>Splenic injury/rupture</b> — trauma; Kehr\'s sign (left shoulder tip pain)',
            '<b>Splenic infarct</b> — sickle cell disease, cardioembolic',
            '<b>Gastric volvulus</b>',
            '<b>Subphrenic abscess</b> (left)',
        ],
        'pharmacology': [
            '<b>Hydroxycarbamide (hydroxyurea)</b> — reduces sickling crises; prevents splenic infarction',
            '<b>Antimalarials</b> (artemisinin-based, chloroquine)',
            '<b>Penicillin V prophylaxis</b> — lifelong post-splenectomy for OPSI prevention',
            '<b>Post-splenectomy vaccines</b>: pneumococcal (PCV13/PPSV23), meningococcal ACWY+B, Hib, annual influenza',
        ],
        'surgery': [
            '<b>Laparoscopic splenectomy</b> — for trauma (grade IV/V), ITP, hereditary spherocytosis',
            '<b>Splenic artery embolization</b> — non-operative for splenic laceration grade I–III',
            '<b>Distal pancreatectomy ± splenectomy</b> for pancreatic tail tumours',
        ],
        'medicine': [
            'Massive splenomegaly causes: CML, myelofibrosis, kala-azar, tropical splenomegaly',
            '<b>Traube\'s space dullness</b> on percussion indicates splenomegaly',
            '<b>OPSI (Overwhelming Post-Splenectomy Infection)</b>: highest risk first 2 years; caused by encapsulated organisms (S. pneumoniae, N. meningitidis, H. influenzae)',
        ],
    },
    {
        'num': '4',
        'name': 'Right Flank (Right Lumbar / Right Lateral)',
        'anatomy': [
            'Right kidney (main body)',
            'Right ureter (upper portion)',
            'Ascending colon',
            'Small intestinal loops',
            'Right psoas muscle, right quadratus lumborum',
        ],
        'pathology': [
            '<b>Renal colic</b> (ureteric stones) — severe colicky loin-to-groin pain, haematuria',
            '<b>Pyelonephritis</b> — loin pain, fever, dysuria; positive CVAT',
            '<b>Renal cell carcinoma (RCC)</b> — classic triad: haematuria + loin pain + mass',
            '<b>Crohn\'s disease</b> (right-sided involvement)',
            '<b>Retroperitoneal fibrosis</b>',
        ],
        'pharmacology': [
            '<b>NSAIDs (diclofenac)</b> — first-line analgesia for renal colic (reduces ureteral spasm)',
            '<b>Alpha-blockers (tamsulosin)</b> — medical expulsive therapy for ureteric stones',
            '<b>Antibiotics for pyelonephritis</b>: ciprofloxacin or co-amoxiclav PO; IV gentamicin + amoxicillin if severe',
            '<b>Sunitinib, pazopanib, nivolumab</b> — targeted/immunotherapy for metastatic RCC',
        ],
        'surgery': [
            '<b>Ureteroscopy + laser lithotripsy</b> for ureteric calculi',
            '<b>ESWL</b> (extracorporeal shock wave lithotripsy) for renal/proximal ureteric stones',
            '<b>PCNL</b> (percutaneous nephrolithotomy) for large staghorn calculi',
            '<b>Radical nephrectomy</b> for RCC',
            '<b>Right hemicolectomy</b> for Crohn\'s stricture / ascending colon cancer',
        ],
        'medicine': [
            '<b>Costovertebral angle tenderness</b> (renal angle) — pyelonephritis vs. renal colic',
            '<b>CT KUB</b> (non-contrast) is gold standard for renal/ureteric calculi',
            'ACE inhibitors/ARBs for renoprotection in diabetic nephropathy',
        ],
    },
    {
        'num': '5',
        'name': 'Umbilical Region (Periumbilical)',
        'anatomy': [
            'Small intestine (jejunum, ileum)',
            'Transverse colon',
            'Abdominal aorta and inferior mesenteric artery origin',
            'Mesentery and mesenteric lymph nodes',
            'Umbilicus',
        ],
        'pathology': [
            '<b>Small bowel obstruction (SBO)</b> — colicky periumbilical pain, distension, vomiting',
            '<b>Abdominal aortic aneurysm (AAA)</b> — pulsatile mass above/at umbilicus; pain → back',
            '<b>Mesenteric ischaemia</b> — "pain out of proportion to signs"; postprandial angina',
            '<b>Umbilical hernia</b>',
            '<b>Early appendicitis</b> — visceral pain starts periumbilical before migrating to RIF',
        ],
        'pharmacology': [
            '<b>IV crystalloids</b> + <b>nasogastric decompression</b> for bowel obstruction',
            '<b>Heparin / warfarin</b> — prevent/treat mesenteric venous thrombosis',
            '<b>Intra-arterial papaverine</b> for non-occlusive mesenteric ischaemia',
            '<b>Statins</b> — slow AAA growth, reduce cardiovascular events',
        ],
        'surgery': [
            '<b>Emergency laparotomy</b> for ruptured AAA; <b>EVAR</b> if anatomically suitable',
            '<b>Elective AAA repair</b>: ≥5.5 cm (men), ≥5 cm (women) or rapid expansion',
            '<b>Adhesiolysis</b> (laparoscopic or open) for adhesion-related SBO',
            '<b>Bowel resection</b> for mesenteric ischaemia with necrosis; second-look at 24–48 h',
            '<b>Umbilical hernia repair</b> — mesh or primary suture',
        ],
        'medicine': [
            '<b>Cullen\'s sign</b> (periumbilical bruising) = haemorrhagic pancreatitis or ruptured ectopic',
            '<b>Sister Mary Joseph nodule</b> = periumbilical lymph node metastasis from intra-abdominal malignancy',
            'SBO: "ladder pattern" (dilated loops with valvulae conniventes) on AXR',
            'Aortic bruit on auscultation → US abdomen for AAA',
        ],
    },
    {
        'num': '6',
        'name': 'Left Flank (Left Lumbar / Left Lateral)',
        'anatomy': [
            'Left kidney (main body)',
            'Left ureter (upper portion)',
            'Descending colon',
            'Small bowel loops',
            'Left psoas muscle, left quadratus lumborum',
        ],
        'pathology': [
            '<b>Renal colic</b> (left ureteric stones)',
            '<b>Pyelonephritis</b> (left)',
            '<b>Polycystic kidney disease (ADPKD)</b> — bilateral flank masses',
            '<b>Descending colon cancer</b> — change in bowel habit, PR bleeding, obstruction',
            '<b>Retroperitoneal haematoma</b>',
        ],
        'pharmacology': [
            'Same as right flank: <b>NSAIDs, tamsulosin</b> for stones; <b>antibiotics</b> for UTI/pyelonephritis',
            '<b>FOLFOX / FOLFIRI</b> (fluorouracil + oxaliplatin or irinotecan) for colon cancer chemotherapy',
            '<b>Bevacizumab</b> (anti-VEGF) — add-on for metastatic colorectal cancer',
            '<b>Tolvaptan</b> — vasopressin V2 receptor antagonist; slows cyst growth in ADPKD',
        ],
        'surgery': [
            'Same urological procedures as right flank (ureteroscopy, ESWL, PCNL)',
            '<b>Left hemicolectomy</b> for descending colon cancer',
            '<b>Bilateral laparoscopic nephrectomy</b> in massive ADPKD prior to transplantation',
        ],
        'medicine': [
            'ADPKD: bilateral flank masses + hypertension + haematuria; associated with berry aneurysms (screen with MRA brain)',
            'Descending colon cancer: presents with <b>obstruction</b> (narrower lumen); less likely to cause iron-deficiency anaemia than right-sided cancer',
        ],
    },
    {
        'num': '7',
        'name': 'Right Iliac Fossa (Right Groin / Right Inguinal Region)',
        'anatomy': [
            'Appendix (retrocaecal in 65% of cases)',
            'Caecum and terminal ileum',
            'Right ovary and right fallopian tube (females)',
            'Right ureter (lower portion)',
            'Inguinal structures: right femoral/inguinal canal',
        ],
        'pathology': [
            '<b>Acute appendicitis</b> — most common surgical emergency worldwide',
            '<b>Ectopic pregnancy</b> (right) — positive β-hCG; no intrauterine pregnancy on US',
            '<b>Ovarian cyst / torsion / Mittelschmerz</b>',
            '<b>Mesenteric adenitis</b> — children; mimics appendicitis',
            '<b>Indirect inguinal hernia</b> — most common, especially males',
            '<b>Crohn\'s disease</b> (terminal ileitis)',
            '<b>Caecal carcinoma / Psoas abscess</b>',
        ],
        'pharmacology': [
            '<b>IV antibiotics peri-appendicectomy</b>: cefuroxime + metronidazole (aerobes + anaerobes)',
            '<b>Piperacillin-tazobactam / meropenem</b> for complicated (perforated) appendicitis',
            '<b>IV morphine</b> — safe to give before diagnosis; does NOT mask peritonism',
            '<b>Methotrexate</b> — medical management of unruptured ectopic pregnancy (β-hCG <3000 IU/L, no cardiac activity)',
            '<b>Infliximab / adalimumab</b> — biologics for Crohn\'s disease',
        ],
        'surgery': [
            '<b>Laparoscopic appendicectomy</b> — standard of care',
            '<b>Open appendicectomy</b> via grid-iron incision at McBurney\'s point (for simple/limited access)',
            '<b>Antibiotic-only management</b> of uncomplicated appendicitis — gaining evidence (APPAC trial)',
            '<b>Inguinal hernia repair</b>: open Lichtenstein (mesh) or laparoscopic TEP/TAPP',
            '<b>Salpingectomy / salpingostomy</b> for ectopic pregnancy',
        ],
        'medicine': [
            '<b>McBurney\'s point</b>: 1/3 from ASIS to umbilicus — maximal tenderness in appendicitis',
            '<b>Rovsing\'s sign</b>: LIF palpation causes RIF pain; <b>Psoas sign</b>; <b>Obturator sign</b>',
            '<b>Alvarado score</b> (MANTRELS) for appendicitis diagnosis; score ≥7 = likely appendicitis',
            'In women of childbearing age: <b>always check β-hCG</b> before attributing RIF pain to appendicitis',
        ],
    },
    {
        'num': '8',
        'name': 'Pubic / Hypogastric Region (Suprapubic)',
        'anatomy': [
            'Urinary bladder',
            'Uterus (body and cervix) and fallopian tubes (females)',
            'Rectum and sigmoid colon junction',
            'Prostate gland (males)',
            'Terminal ureters; seminal vesicles (males)',
        ],
        'pathology': [
            '<b>Pelvic inflammatory disease (PID)</b> — bilateral lower abdominal pain, vaginal discharge, cervical excitation',
            '<b>Ovarian cysts / torsion</b>',
            '<b>Cystitis / UTI</b> — suprapubic pain, dysuria, frequency',
            '<b>Bladder cancer</b> — painless haematuria',
            '<b>Uterine fibroids</b> — menorrhagia, pressure symptoms',
            '<b>BPH / Prostate cancer</b> (males)',
            '<b>Pelvic abscess</b> (Pouch of Douglas)',
        ],
        'pharmacology': [
            '<b>PID antibiotics</b>: doxycycline + metronidazole ± ceftriaxone (covers Chlamydia, Gonorrhoea, anaerobes)',
            '<b>Antibiotics for UTI</b>: trimethoprim/nitrofurantoin (uncomplicated); ciprofloxacin (complicated)',
            '<b>Anticholinergics</b> (oxybutynin, solifenacin) for overactive bladder',
            '<b>5-alpha reductase inhibitors</b> (finasteride) + <b>alpha-blockers</b> (tamsulosin) for BPH',
            '<b>GnRH agonists</b> (leuprolide) for fibroid management (preoperative medical menopause)',
        ],
        'surgery': [
            '<b>Laparoscopic drainage</b> of Pouch of Douglas abscess',
            '<b>TURP / laser prostatectomy</b> for BPH',
            '<b>Radical cystectomy + neobladder</b> for muscle-invasive bladder cancer',
            '<b>Total abdominal hysterectomy ± BSO (TAH-BSO)</b> for fibroids/gynaecological cancer',
            '<b>Colporrhaphy</b> (anterior/posterior repair) for pelvic organ prolapse',
        ],
        'medicine': [
            '<b>Fitz-Hugh-Curtis syndrome</b>: RUQ pain (perihepatic adhesions) secondary to ascending PID — mimics cholecystitis',
            '<b>Chandelier sign</b> (cervical motion tenderness) = PID',
            'PSA + TRUS-guided biopsy for prostate cancer; <b>Gleason score</b> for grading',
            'Transvaginal US — first-line for ovarian/uterine pathology',
        ],
    },
    {
        'num': '9',
        'name': 'Left Iliac Fossa (Left Groin / Left Inguinal Region)',
        'anatomy': [
            'Sigmoid colon and lower descending colon',
            'Left ovary and left fallopian tube (females)',
            'Left ureter (lower portion)',
            'Left inguinal structures',
            'Left psoas muscle (lower)',
        ],
        'pathology': [
            '<b>Diverticulitis</b> — "left-sided appendicitis"; older patients; LIF pain, fever, altered bowel habit',
            '<b>Diverticular abscess / perforation</b> — peritonitis, pneumoperitoneum',
            '<b>Sigmoid colon cancer</b> — change in bowel habit, PR bleeding, obstruction',
            '<b>Ectopic pregnancy</b> (left)',
            '<b>Ovarian pathology</b> (left) — cyst, torsion',
            '<b>Left inguinal hernia</b>',
        ],
        'pharmacology': [
            '<b>Antibiotics for uncomplicated diverticulitis</b>: metronidazole + ciprofloxacin PO; IV co-amoxiclav or pip-taz if severe',
            'Recent evidence (AVOD/DIABOLO trials): antibiotics may not be needed for uncomplicated acute diverticulitis',
            '<b>FOLFOX / FOLFIRI + bevacizumab</b> for metastatic sigmoid colon cancer',
            '<b>Osmotic laxatives</b> (lactulose, macrogol) and <b>stimulant laxatives</b> (senna) for constipation',
            '<b>High-fibre diet</b> — prevents diverticular disease progression',
        ],
        'surgery': [
            '<b>Hartmann\'s procedure</b> — emergency sigmoid resection + end colostomy (Hinchey III/IV peritonitis)',
            '<b>Laparoscopic sigmoid colectomy</b> — elective for recurrent/complicated diverticulitis',
            '<b>Anterior resection</b> — for sigmoid/upper rectal cancer (± defunctioning ileostomy)',
            '<b>Abdominoperineal resection (APR)</b> — for low rectal cancer where sphincter cannot be preserved',
        ],
        'medicine': [
            '<b>Hinchey classification</b> for perforated diverticulitis: I (pericolic abscess) → IV (faecal peritonitis)',
            'CT abdomen/pelvis with IV contrast = investigation of choice for diverticulitis',
            'Colonoscopy contraindicated in <b>acute</b> diverticulitis; perform 6–8 weeks after resolution',
            '<b>Diverticular disease</b> (asymptomatic) vs. <b>diverticulitis</b> (infected/inflamed)',
        ],
    },
]

section_colors = [
    colors.HexColor('#1a237e'),  # deep blue
    colors.HexColor('#4a148c'),  # deep purple
    colors.HexColor('#006064'),  # teal
    colors.HexColor('#b71c1c'),  # deep red
    colors.HexColor('#1b5e20'),  # deep green
    colors.HexColor('#e65100'),  # deep orange
    colors.HexColor('#880e4f'),  # deep pink
    colors.HexColor('#37474f'),  # dark slate
    colors.HexColor('#4e342e'),  # brown
]

sub_headers = ['Anatomy', 'Pathology', 'Pharmacology (POM)', 'Surgery', 'Medicine']
sub_keys = ['anatomy', 'pathology', 'pharmacology', 'surgery', 'medicine']
sub_colors = [
    colors.HexColor('#1565c0'),
    colors.HexColor('#6a1b9a'),
    colors.HexColor('#00695c'),
    colors.HexColor('#b71c1c'),
    colors.HexColor('#2e7d32'),
]

for i, region in enumerate(regions):
    col = section_colors[i]
    
    # Region heading
    h1_p = ParagraphStyle(f'H1_{i}', parent=h1_style, backColor=col)
    story.append(Paragraph(f'&nbsp;&nbsp;Region {region["num"]}: {region["name"]}', h1_p))
    story.append(sp(0.5))
    
    for j, (key, label) in enumerate(zip(sub_keys, sub_headers)):
        sub_col = sub_colors[j]
        h2_p = ParagraphStyle(f'H2_{i}_{j}', parent=h2_style, 
                               textColor=sub_col,
                               borderPad=4)
        story.append(Paragraph(f'▶ {label}', h2_p))
        for item in region[key]:
            story.append(Paragraph(f'• {item}', bullet_style))
        story.append(sp(0.5))
    
    story.append(hr())
    if i < len(regions) - 1 and i in [2, 5]:
        story.append(PageBreak())
    else:
        story.append(sp())

# ── SUMMARY TABLE ──────────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(Paragraph('&nbsp;&nbsp;Summary Table — All 9 Abdominal Regions', 
    ParagraphStyle('H1Sum', parent=h1_style, backColor=colors.HexColor('#37474f'))))
story.append(sp())

table_data = [
    ['Region', 'Key Organs', 'Key Pathology', 'Key Surgery', 'Key Drug(s)'],
    ['R. Hypochondrium', 'Liver, Gallbladder', 'Cholecystitis, Hepatitis, HCC', 'Lap cholecystectomy, Hepatectomy', 'Ursodeoxycholic acid, Antivirals'],
    ['Epigastric', 'Stomach, Pancreas, Aorta', 'PUD, Pancreatitis, AAA', 'Whipple\'s, Gastrectomy, EVAR', 'PPIs, H. pylori triple therapy'],
    ['L. Hypochondrium', 'Spleen, Stomach fundus', 'Splenomegaly, Splenic rupture', 'Splenectomy, Distal pancreatectomy', 'Penicillin V, Hydroxyurea'],
    ['R. Flank', 'R. Kidney, Ascending colon', 'Renal colic, Pyelonephritis, RCC', 'Nephrectomy, Ureteroscopy, PCNL', 'NSAIDs, Tamsulosin, Ciprofloxacin'],
    ['Umbilical', 'Small bowel, Aorta', 'SBO, AAA, Mesenteric ischaemia', 'Laparotomy, EVAR, Adhesiolysis', 'IV fluids, Heparin, Statins'],
    ['L. Flank', 'L. Kidney, Descending colon', 'Renal colic, Colon cancer, PKD', 'Hemicolectomy, Nephrectomy', 'FOLFOX, Tolvaptan, Tamsulosin'],
    ['R. Iliac Fossa', 'Appendix, Caecum, R. Ovary', 'Appendicitis, Ectopic, Crohn\'s', 'Appendicectomy, Hernia repair', 'Cefuroxime + Metronidazole'],
    ['Pubic/Hypogastric', 'Bladder, Uterus, Prostate', 'PID, Cystitis, BPH, Bladder Ca', 'Cystectomy, TURP, Hysterectomy', 'Doxycycline, Tamsulosin, Nitrofurantoin'],
    ['L. Iliac Fossa', 'Sigmoid colon, L. Ovary', 'Diverticulitis, Sigmoid Ca, Ectopic', 'Hartmann\'s, Anterior resection', 'Metronidazole + Ciprofloxacin'],
]

col_widths = [3.2*cm, 3.8*cm, 4.2*cm, 4.2*cm, 3.6*cm]
tbl = Table(table_data, colWidths=col_widths, repeatRows=1)
tbl.setStyle(TableStyle([
    # Header
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#37474f')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,0), 8),
    ('ALIGN', (0,0), (-1,0), 'CENTER'),
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    # Body
    ('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
    ('FONTSIZE', (0,1), (-1,-1), 7.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f5f5f5'), colors.white]),
    ('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#bdbdbd')),
    ('LEFTPADDING', (0,0), (-1,-1), 4),
    ('RIGHTPADDING', (0,0), (-1,-1), 4),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    # Color first column
    ('BACKGROUND', (0,1), (0,-1), colors.HexColor('#e3f2fd')),
    ('FONTNAME', (0,1), (0,-1), 'Helvetica-Bold'),
]))
story.append(tbl)
story.append(sp(2))

# ── FOOTER REFERENCES ──────────────────────────────────────────────────────────
story.append(HRFlowable(width='100%', thickness=1, color=colors.HexColor('#90a4ae'), spaceAfter=6))
story.append(Paragraph('<b>References / Sources</b>', h2_style))
refs = [
    "Gray's Anatomy for Students — Nine-region pattern, Block 2 (p. 336)",
    "Bailey and Love's Short Practice of Surgery, 28th Edition — Figure 63.2",
    "Tintinalli's Emergency Medicine — Abdominal pain, Appendicitis, Peptic Ulcer Disease",
    "Rosen's Emergency Medicine — Abdominal quadrant pain differential diagnosis",
    "Sleisenger & Fordtran's Gastrointestinal and Liver Disease — Pancreatitis, Diverticulitis",
    "Yamada's Textbook of Gastroenterology, 7th Edition — Clinical features of peptic ulcer disease",
    "Smith & Tanagho's General Urology, 19th Edition — Renal and ureteric pain",
    "Sabiston Textbook of Surgery — Surgical management of abdominal conditions",
]
for ref in refs:
    story.append(Paragraph(f'• {ref}', bullet_style))

doc.build(story)
print('PDF created:', OUTPUT)