Pediatric GI Case Format - Complete History Taking with Clinical Reasoning

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

# ── Colour palette ──────────────────────────────────────────────
TEAL        = HexColor("#0D6E6E")   # dominant
TEAL_LIGHT  = HexColor("#E8F5F5")   # row shading
TEAL_MID    = HexColor("#B2DFDB")   # sub-header bg
ORANGE      = HexColor("#E65100")   # red-flag accent
ORANGE_PALE = HexColor("#FFF3E0")   # red-flag row bg
GREY_DARK   = HexColor("#37474F")   # body text
GREY_LIGHT  = HexColor("#F5F7F8")   # alt row
WHITE       = colors.white
BLACK       = colors.black

PAGE_W, PAGE_H = A4

OUTPUT = "/home/daytona/workspace/peds-gi-schema/Pediatric_GI_Examination_Schema.pdf"

# ── Page template with header/footer ────────────────────────────
class DocTemplate(SimpleDocTemplate):
    def __init__(self, filename, **kw):
        super().__init__(filename, **kw)

    def handle_pageBegin(self):
        self._handle_pageBegin()

def add_header_footer(canvas_obj, doc):
    canvas_obj.saveState()
    w, h = A4
    # Top bar
    canvas_obj.setFillColor(TEAL)
    canvas_obj.rect(0, h - 22*mm, w, 22*mm, fill=1, stroke=0)
    canvas_obj.setFillColor(WHITE)
    canvas_obj.setFont("Helvetica-Bold", 13)
    canvas_obj.drawString(18*mm, h - 13*mm, "PEDIATRIC GI EXAMINATION SCHEMA")
    canvas_obj.setFont("Helvetica", 9)
    canvas_obj.drawRightString(w - 18*mm, h - 10*mm, "All Ages | Paired with GI History Format")
    canvas_obj.drawRightString(w - 18*mm, h - 15*mm, f"Page {doc.page}")
    # Bottom bar
    canvas_obj.setFillColor(TEAL)
    canvas_obj.rect(0, 0, w, 8*mm, fill=1, stroke=0)
    canvas_obj.setFillColor(WHITE)
    canvas_obj.setFont("Helvetica-Oblique", 7.5)
    canvas_obj.drawString(18*mm, 2.5*mm,
        "Clinical examination findings to pair with Pediatric GI History Format  |  "
        "Sources: Tintinalli's Emergency Medicine; Bailey & Love's Surgery; Family Medicine 9e")
    canvas_obj.restoreState()

# ── Style helpers ────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    base = styles["Normal"]
    return ParagraphStyle(name, parent=base, **kw)

BODY   = S("body",   fontSize=8.5,  leading=12,  textColor=GREY_DARK)
BOLD   = S("bold",   fontSize=8.5,  leading=12,  textColor=GREY_DARK,  fontName="Helvetica-Bold")
RED    = S("red",    fontSize=8.5,  leading=12,  textColor=ORANGE,     fontName="Helvetica-Bold")
SMALL  = S("small",  fontSize=7.5,  leading=10,  textColor=GREY_DARK,  fontName="Helvetica-Oblique")
SMRED  = S("smred",  fontSize=7.5,  leading=10,  textColor=ORANGE,     fontName="Helvetica-Bold")
TITLE_S= S("titls",  fontSize=11,   leading=14,  textColor=WHITE,      fontName="Helvetica-Bold")
SEC    = S("sec",    fontSize=9.5,  leading=13,  textColor=WHITE,      fontName="Helvetica-Bold")
SECBIG = S("secbig", fontSize=10,   leading=14,  textColor=WHITE,      fontName="Helvetica-Bold")

COL_W = [5.5*cm, 6.5*cm, 6.5*cm]   # Finding | Normal/Abnormal | Clinical Significance
COL_W2 = [5.5*cm, 13*cm]            # two-col rows

def section_header(title, color=TEAL):
    """Full-width coloured section banner."""
    t = Table([[Paragraph(title, SEC)]], colWidths=[PAGE_W - 36*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING",  (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
    ]))
    return t

def col_header_row(labels):
    row = [Paragraph(f"<b>{l}</b>", S("ch", fontSize=8, leading=11,
           textColor=WHITE, fontName="Helvetica-Bold")) for l in labels]
    return row

def make_table(rows, col_widths=None, alt=True, header_row=None):
    """Build a styled 3-col table."""
    cw = col_widths or COL_W
    data = []
    if header_row:
        data.append(header_row)
    data.extend(rows)

    t = Table(data, colWidths=cw, repeatRows=1 if header_row else 0)

    style_cmds = [
        ("FONTNAME",  (0,0), (-1,-1), "Helvetica"),
        ("FONTSIZE",  (0,0), (-1,-1), 8.5),
        ("LEADING",   (0,0), (-1,-1), 12),
        ("VALIGN",    (0,0), (-1,-1), "TOP"),
        ("TOPPADDING",(0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING",(0,0),(-1,-1), 5),
        ("RIGHTPADDING",(0,0),(-1,-1), 5),
        ("GRID",      (0,0), (-1,-1), 0.25, HexColor("#CFD8DC")),
    ]
    if header_row:
        style_cmds += [
            ("BACKGROUND",(0,0),(-1,0), TEAL_MID),
            ("FONTNAME",  (0,0),(-1,0), "Helvetica-Bold"),
            ("FONTSIZE",  (0,0),(-1,0), 8),
            ("TEXTCOLOR", (0,0),(-1,0), GREY_DARK),
        ]
    if alt:
        start = 1 if header_row else 0
        for i in range(start, len(data)):
            bg = GREY_LIGHT if i % 2 == (1 if header_row else 0) else WHITE
            style_cmds.append(("BACKGROUND",(0,i),(-1,i), bg))

    t.setStyle(TableStyle(style_cmds))
    return t

def red_flag_table(rows):
    """Red-flag styled 3-col table."""
    cw = [5*cm, 6*cm, 7.5*cm]
    header = [Paragraph(f"<b>{l}</b>", S("rh", fontSize=8, leading=11,
              textColor=WHITE, fontName="Helvetica-Bold"))
              for l in ["Red Flag Sign", "How to Elicit", "Clinical Significance"]]
    data = [header] + rows
    t = Table(data, colWidths=cw, repeatRows=1)
    style_cmds = [
        ("FONTNAME",  (0,0),(-1,-1), "Helvetica"),
        ("FONTSIZE",  (0,0),(-1,-1), 8.5),
        ("LEADING",   (0,0),(-1,-1), 12),
        ("VALIGN",    (0,0),(-1,-1), "TOP"),
        ("TOPPADDING",(0,0),(-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING",(0,0),(-1,-1), 5),
        ("RIGHTPADDING",(0,0),(-1,-1), 5),
        ("GRID",      (0,0),(-1,-1), 0.25, HexColor("#FFCCBC")),
        ("BACKGROUND",(0,0),(-1,0), ORANGE),
        ("FONTNAME",  (0,0),(-1,0), "Helvetica-Bold"),
        ("TEXTCOLOR", (0,0),(-1,0), WHITE),
    ]
    for i in range(1, len(data)):
        bg = ORANGE_PALE if i % 2 == 1 else WHITE
        style_cmds.append(("BACKGROUND",(0,i),(-1,i), bg))
    t.setStyle(TableStyle(style_cmds))
    return t

def note_box(text):
    data = [[Paragraph(text, S("nb", fontSize=8, leading=11,
             textColor=GREY_DARK, fontName="Helvetica-Oblique"))]]
    t = Table(data, colWidths=[PAGE_W - 36*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), HexColor("#E3F2FD")),
        ("LEFTPADDING",(0,0),(-1,-1), 8),
        ("TOPPADDING", (0,0),(-1,-1), 5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 5),
        ("BOX",(0,0),(-1,-1), 0.5, HexColor("#1565C0")),
    ]))
    return t

# ── CONTENT BUILDER ──────────────────────────────────────────────
story = []

# ── INTRO BOX ──
intro_data = [[
    Paragraph("<b>PURPOSE</b>", S("ib", fontSize=9, fontName="Helvetica-Bold", textColor=TEAL)),
    Paragraph(
        "Systematic physical examination guide for paediatric GI complaints. "
        "Each finding paired with its clinical significance and age-specific notes. "
        "Always examine the <b>anxious child last</b> (leave painful areas to the end). "
        "Warm hands, distract with conversation, and observe from the end of the bed first.",
        S("ib2", fontSize=8.5, leading=12, textColor=GREY_DARK))
]]
it = Table(intro_data, colWidths=[3*cm, PAGE_W - 36*mm - 3*cm])
it.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), TEAL_LIGHT),
    ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
    ("TOPPADDING",(0,0),(-1,-1),7),
    ("BOTTOMPADDING",(0,0),(-1,-1),7),
    ("LEFTPADDING",(0,0),(-1,-1),8),
    ("BOX",(0,0),(-1,-1),0.75,TEAL),
]))
story.append(it)
story.append(Spacer(1, 5*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 1: GENERAL INSPECTION
# ═══════════════════════════════════════════════════════════════
story.append(section_header("1. GENERAL INSPECTION  (Before Touching the Child)"))
story.append(Spacer(1, 1*mm))

hdr = [Paragraph(f"<b>{l}</b>", S("h", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold"))
       for l in ["What to Look For", "Normal Finding", "Abnormal / Significance"]]

gen_rows = [
    [Paragraph("Appearance & distress", BOLD),
     Paragraph("Comfortable, playing, alert", BODY),
     Paragraph("Lying still, knees drawn up (peritonitis). Rolling/writhing (colic). Lethargic (dehydration, sepsis).", BODY)],
    [Paragraph("Nutritional state / growth", BOLD),
     Paragraph("Weight appropriate for age", BODY),
     Paragraph("Wasted/thin = chronic disease (IBD, coeliac, CF, malignancy). Oedema = hypoalbuminaemia (liver failure, protein-losing enteropathy).", BODY)],
    [Paragraph("Skin colour", BOLD),
     Paragraph("Pink, well-perfused", BODY),
     Paragraph("Jaundice (bilirubin >35 µmol/L). Pallor (anaemia from GI bleed, coeliac). Mottling/grey = shock.", BODY)],
    [Paragraph("Face: eyes, mouth", BOLD),
     Paragraph("Moist mucous membranes, clear eyes", BODY),
     Paragraph("Sunken eyes, dry lips = dehydration. Aphthous ulcers = Crohn's disease. Angular stomatitis = iron/B12 deficiency (coeliac).", BODY)],
    [Paragraph("Hands & nails", BOLD),
     Paragraph("Pink, normal capillary refill <2 sec", BODY),
     Paragraph("Clubbing = IBD, CF, liver cirrhosis. Koilonychia = iron deficiency. Leuconychia = hypoalbuminaemia. Palmar erythema = liver disease.", BODY)],
    [Paragraph("Posture / gait", BOLD),
     Paragraph("Normal movement", BODY),
     Paragraph("Child walks bent over / guards abdomen = peritonism. Refuses to jump/walk on heels = peritoneal irritation (ask child to hop).", BODY)],
]
story.append(make_table(gen_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 2: VITAL SIGNS
# ═══════════════════════════════════════════════════════════════
story.append(section_header("2. VITAL SIGNS  (Age-Referenced)"))
story.append(Spacer(1, 1*mm))

vs_rows = [
    [Paragraph("Temperature", BOLD),
     Paragraph("36.5-37.5 °C", BODY),
     Paragraph("Fever >38°C: appendicitis, gastroenteritis, IBD, mesenteric adenitis, cholangitis. Hypothermia in neonates = sepsis.", BODY)],
    [Paragraph("Heart Rate\n<i>(Tachycardia = early dehydration/pain)</i>", S("bi", fontSize=8.5, leading=12, textColor=GREY_DARK, fontName="Helvetica-BoldOblique")),
     Paragraph("Neonate: 120-160\nInfant: 100-160\nToddler: 90-150\nSchool-age: 70-120", BODY),
     Paragraph("Persistent tachycardia beyond pain control = dehydration or haemorrhage. Bradycardia in sick child = pre-arrest.", BODY)],
    [Paragraph("Blood Pressure", BOLD),
     Paragraph("Age-appropriate (roughly 90 + 2×age mmHg systolic)", BODY),
     Paragraph("Hypotension = late dehydration, haemorrhagic shock, sepsis. Hypertension in GI context = Henoch-Schonlein purpura (renal involvement).", BODY)],
    [Paragraph("Respiratory Rate", BOLD),
     Paragraph("Infant: <50/min\nToddler: <40/min\nSchool-age: <30/min", BODY),
     Paragraph("Tachypnoea = metabolic acidosis (severe dehydration), right lower lobe pneumonia (mimics abdominal pain), diaphragmatic irritation.", BODY)],
    [Paragraph("Capillary Refill Time", BOLD),
     Paragraph("<2 seconds centrally", BODY),
     Paragraph("2-3 sec = mild-moderate dehydration. >3 sec = poor perfusion, shock. Assess centrally (sternum) not peripherally in cold child.", BODY)],
    [Paragraph("Weight (plot on chart)", BOLD),
     Paragraph("Following expected centile", BODY),
     Paragraph("Crossing 2 centile lines downward = significant failure to thrive. Essential for fluid/drug dosing and nutritional assessment.", BODY)],
]
story.append(make_table(vs_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 3: HANDS, EYES, MOUTH (PERIPHERAL SIGNS)
# ═══════════════════════════════════════════════════════════════
story.append(section_header("3. PERIPHERAL SIGNS  (Hands → Eyes → Mouth → Neck)"))
story.append(Spacer(1, 1*mm))

periph_rows = [
    [Paragraph("HANDS", RED),
     Paragraph("", BODY), Paragraph("", BODY)],
    [Paragraph("Clubbing", BOLD),
     Paragraph("Absent (Schamroth's window visible)", BODY),
     Paragraph("IBD (especially Crohn's), CF, liver cirrhosis, coeliac. Confirm: loss of Schamroth's window, fluctuant nail base.", BODY)],
    [Paragraph("Koilonychia (spoon nails)", BOLD),
     Paragraph("Normal convex nails", BODY),
     Paragraph("Chronic iron deficiency = coeliac disease, IBD, GI blood loss.", BODY)],
    [Paragraph("Leuconychia", BOLD),
     Paragraph("Pink nails, no white bands", BODY),
     Paragraph("Hypoalbuminaemia = liver failure, protein-losing enteropathy, malabsorption.", BODY)],
    [Paragraph("Palmar erythema", BOLD),
     Paragraph("Normal skin tone", BODY),
     Paragraph("Chronic liver disease (hyperdynamic circulation). Also physiological in pregnancy.", BODY)],
    [Paragraph("Dupuytren's contracture", BOLD),
     Paragraph("Full hand extension", BODY),
     Paragraph("Rare in children; if present = liver disease (alcoholic cirrhosis in adults; in children, consider genetic liver disease).", BODY)],
    [Paragraph("EYES", RED),
     Paragraph("", BODY), Paragraph("", BODY)],
    [Paragraph("Scleral icterus (jaundice)", BOLD),
     Paragraph("White sclera", BODY),
     Paragraph("Earliest sign of jaundice. Appears at bilirubin ~35 µmol/L (before skin jaundice). Confirms hepatic/haemolytic pathology.", BODY)],
    [Paragraph("Conjunctival pallor", BOLD),
     Paragraph("Pink conjunctivae", BODY),
     Paragraph("Anaemia from: GI blood loss, coeliac (B12/folate/iron malabsorption), IBD. Pull down lower lid gently.", BODY)],
    [Paragraph("Sunken eyes", BOLD),
     Paragraph("Normal eye fullness", BODY),
     Paragraph("Dehydration. Assess alongside skin turgor and mucous membranes. Sunken eyes = moderate-severe dehydration (>5-10% body weight).", BODY)],
    [Paragraph("Kayser-Fleischer rings", BOLD),
     Paragraph("Clear iris/cornea", BODY),
     Paragraph("Wilson's disease (hepatolenticular degeneration) - copper deposits in Descemet's membrane. Requires slit-lamp. Consider in child with liver disease + neuro symptoms.", BODY)],
    [Paragraph("MOUTH", RED),
     Paragraph("", BODY), Paragraph("", BODY)],
    [Paragraph("Mucous membranes - moisture", BOLD),
     Paragraph("Moist, pink", BODY),
     Paragraph("Dry/tacky = dehydration. Key dehydration sign in infants (crying without tears is complementary).", BODY)],
    [Paragraph("Aphthous ulcers", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Crohn's disease. Can precede intestinal symptoms by years. Also seen in coeliac, Behcet's, nutritional deficiency.", BODY)],
    [Paragraph("Angular stomatitis / glossitis", BOLD),
     Paragraph("Intact lip angles, normal tongue", BODY),
     Paragraph("Iron, B2, B12 deficiency = malabsorption (coeliac, IBD). Smooth glossy tongue = B12/folate deficiency.", BODY)],
    [Paragraph("Dental erosions", BOLD),
     Paragraph("Normal enamel", BODY),
     Paragraph("Chronic GERD (acid erosion of posterior teeth). Important sign in older children/adolescents with reflux.", BODY)],
    [Paragraph("NECK", RED),
     Paragraph("", BODY), Paragraph("", BODY)],
    [Paragraph("Lymphadenopathy", BOLD),
     Paragraph("No palpable nodes", BODY),
     Paragraph("Mesenteric adenitis (enlarged mesenteric nodes causing abdominal pain, often confused with appendicitis). Generalised nodes = IBD, lymphoma.", BODY)],
]

# mark section sub-rows
periph_data = periph_rows
t = Table([[Paragraph(f"<b>{l}</b>", S("h", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold"))
            for l in ["Sign", "Normal", "Abnormal / Significance"]]] + periph_data,
          colWidths=COL_W, repeatRows=1)

style = [
    ("FONTNAME",  (0,0),(-1,-1),"Helvetica"),
    ("FONTSIZE",  (0,0),(-1,-1),8.5),
    ("LEADING",   (0,0),(-1,-1),12),
    ("VALIGN",    (0,0),(-1,-1),"TOP"),
    ("TOPPADDING",(0,0),(-1,-1),4),
    ("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("GRID",      (0,0),(-1,-1),0.25,HexColor("#CFD8DC")),
    ("BACKGROUND",(0,0),(-1,0), TEAL_MID),
    ("FONTNAME",  (0,0),(-1,0),"Helvetica-Bold"),
    ("FONTSIZE",  (0,0),(-1,0),8),
]
# highlight section dividers (HANDS, EYES, MOUTH, NECK rows)
divider_rows = [i+1 for i,r in enumerate(periph_data)
                if isinstance(r[0], Paragraph) and r[0].style.name == "red"]
for dr in divider_rows:
    style.append(("BACKGROUND",(0,dr),(-1,dr), HexColor("#FFF8E1")))
    style.append(("FONTNAME",(0,dr),(-1,dr),"Helvetica-Bold"))

for i in range(1, len(periph_data)+1):
    if i not in divider_rows:
        bg = GREY_LIGHT if i % 2 == 1 else WHITE
        style.append(("BACKGROUND",(0,i),(-1,i),bg))

t.setStyle(TableStyle(style))
story.append(t)
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 4: ABDOMINAL EXAMINATION
# ═══════════════════════════════════════════════════════════════
story.append(section_header("4. ABDOMINAL EXAMINATION"))
story.append(Spacer(1, 1*mm))

story.append(note_box(
    "SEQUENCE: Inspection → Auscultation → LIGHT palpation → DEEP palpation → Percussion → Special tests  |  "
    "Always ask 'Show me where it hurts' first and leave that area last  |  "
    "Watch the child's face, not your hand, during palpation"))
story.append(Spacer(1, 2*mm))

# 4a Inspection
story.append(Table([[Paragraph("4a. INSPECTION", S("sub", fontSize=9, textColor=TEAL, fontName="Helvetica-Bold"))]],
             colWidths=[PAGE_W-36*mm]))
story.append(Spacer(1,1*mm))

ins_rows = [
    [Paragraph("Abdominal shape / contour", BOLD),
     Paragraph("Slightly protuberant in toddlers (normal). Flat in older children.", BODY),
     Paragraph("Distension: gaseous (obstruction, aerophagia, constipation) vs fluid (ascites - flanks full). Scaphoid = severe malnutrition.", BODY)],
    [Paragraph("Visible peristalsis", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Visible gastric peristalsis (left → right) in infant = pyloric stenosis. Visible bowel loops = obstruction.", BODY)],
    [Paragraph("Umbilicus", BOLD),
     Paragraph("Central, inverted", BODY),
     Paragraph("Everted = raised intra-abdominal pressure (ascites, mass, organomegaly). Displaced = mass effect.", BODY)],
    [Paragraph("Skin: scars, striae, collateral veins", BOLD),
     Paragraph("Intact skin, no scarring", BODY),
     Paragraph("Surgical scars = adhesions risk. Caput medusae (dilated veins radiating from umbilicus) = portal hypertension. Striae = rapid weight change, Cushing's.", BODY)],
    [Paragraph("Visible mass or asymmetry", BOLD),
     Paragraph("Symmetric", BODY),
     Paragraph("Wilms tumour (nephroblastoma), intussusception mass, hepatosplenomegaly, faecal loading (left iliac fossa). Any visible mass = urgent imaging.", BODY)],
    [Paragraph("Movement with respiration", BOLD),
     Paragraph("Abdomen moves freely with breathing", BODY),
     Paragraph("Abdomen not moving with respiration = peritonitis (child splints abdomen). Paradoxical breathing in infant = respiratory distress.", BODY)],
]
story.append(make_table(ins_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1,2*mm))

# 4b Auscultation
story.append(Table([[Paragraph("4b. AUSCULTATION  (Before palpation - palpation changes bowel sounds)", S("sub", fontSize=9, textColor=TEAL, fontName="Helvetica-Bold"))]],
             colWidths=[PAGE_W-36*mm]))
story.append(Spacer(1,1*mm))

aus_rows = [
    [Paragraph("Bowel sounds", BOLD),
     Paragraph("Intermittent gurgles every 5-10 sec", BODY),
     Paragraph("Absent (>2 min silence) = ileus (post-op, peritonitis, severe inflammation). High-pitched/tinkling = mechanical obstruction. Borborygmi = gastroenteritis, IBS.", BODY)],
    [Paragraph("Hepatic bruit", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Hepatocellular carcinoma, hepatic haemangioma (infant), AV malformation.", BODY)],
    [Paragraph("Renal bruit (flanks)", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Renal artery stenosis (rare in children; consider in resistant hypertension).", BODY)],
    [Paragraph("Succussion splash", BOLD),
     Paragraph("Absent when shaking abdomen", BODY),
     Paragraph("Audible splash >3 hrs post-feed = gastric outlet obstruction (pyloric stenosis, antral web).", BODY)],
]
story.append(make_table(aus_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1,2*mm))

# 4c Palpation
story.append(Table([[Paragraph("4c. PALPATION  (Start away from pain, use warm hands, child supine with knees flexed)", S("sub", fontSize=9, textColor=TEAL, fontName="Helvetica-Bold"))]],
             colWidths=[PAGE_W-36*mm]))
story.append(Spacer(1,1*mm))

palp_rows = [
    [Paragraph("Voluntary guarding", BOLD),
     Paragraph("Abdomen soft, relaxed", BODY),
     Paragraph("Child tenses abdomen when you approach = voluntary (pain anticipation). Distinguish from involuntary guarding (persists despite distraction).", BODY)],
    [Paragraph("Involuntary guarding / rigidity", BOLD),
     Paragraph("Absent - abdomen remains relaxed", BODY),
     Paragraph("Board-like rigidity = peritonitis (perforation, appendicitis, ruptured viscus). Rigid abdomen is a surgical emergency.", BODY)],
    [Paragraph("Tenderness - general vs localised", BOLD),
     Paragraph("Non-tender on gentle palpation", BODY),
     Paragraph("Localised RIF = appendicitis (McBurney's point: 1/3 from ASIS to umbilicus). Generalised = peritonitis, gastroenteritis. Epigastric = peptic ulcer, pancreatitis.", BODY)],
    [Paragraph("Liver edge (start RIF, move upward)", BOLD),
     Paragraph("Up to 2 cm below costal margin is normal in infants/toddlers", BODY),
     Paragraph(">3 cm in infants or any in school-age = hepatomegaly. Note texture: smooth (hepatitis, congestion) vs nodular (cirrhosis, storage disease, malignancy).", BODY)],
    [Paragraph("Spleen (start RIF, move toward LUQ)", BOLD),
     Paragraph("Not palpable (or barely tip in young infant)", BODY),
     Paragraph("Splenomegaly: portal hypertension, haemolytic anaemia (sickle cell, spherocytosis), EBV, storage diseases. Massive = malaria, CML.", BODY)],
    [Paragraph("Hepatosplenomegaly", BOLD),
     Paragraph("Not present", BODY),
     Paragraph("Both enlarged = portal hypertension, storage disease (Gaucher's, Niemann-Pick), EBV, leukaemia, haemolytic conditions.", BODY)],
    [Paragraph("Kidneys (ballottement)", BOLD),
     Paragraph("Not palpable in older children. Neonates: tip occasionally felt.", BODY),
     Paragraph("Palpable enlarged kidney = Wilms tumour (hard, smooth, crosses midline), hydronephrosis, PCKD. Wilms is the most common paediatric abdominal tumour.", BODY)],
    [Paragraph("Palpable faecal mass", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Left iliac fossa or suprapubic = constipation (indentable, non-tender). Right iliac fossa mass = appendix mass/abscess, Crohn's ileocaecal mass, caecal carcinoma.", BODY)],
    [Paragraph("Palpable bowel loop / sausage shape", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("'Sausage-shaped mass' in RUQ or across abdomen = intussusception. Often with empty RIF (Dance's sign = absence of bowel in RIF). Urgent US needed.", BODY)],
    [Paragraph("Inguinal hernias / testes", BOLD),
     Paragraph("Absent hernias. Testes descended bilaterally.", BODY),
     Paragraph("Incarcerated inguinal hernia = obstruction. Undescended testes. Always examine groin in any child with abdominal pain.", BODY)],
]
story.append(make_table(palp_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1,2*mm))

# 4d Percussion
story.append(Table([[Paragraph("4d. PERCUSSION", S("sub", fontSize=9, textColor=TEAL, fontName="Helvetica-Bold"))]],
             colWidths=[PAGE_W-36*mm]))
story.append(Spacer(1,1*mm))

perc_rows = [
    [Paragraph("General tympany vs dullness", BOLD),
     Paragraph("Tympanic over most of abdomen", BODY),
     Paragraph("Dullness = fluid, solid mass, organomegaly. Hyper-resonance = gaseous distension (obstruction, aerophagia).", BODY)],
    [Paragraph("Liver dullness span", BOLD),
     Paragraph("Dull zone: ~6-8 cm in school-age", BODY),
     Paragraph("Increased liver span = hepatomegaly. Loss of liver dullness = pneumoperitoneum (air under diaphragm = perforation = emergency).", BODY)],
    [Paragraph("Shifting dullness", BOLD),
     Paragraph("Absent - dullness does not shift with position", BODY),
     Paragraph("Positive = ascites (>500 mL). Causes: liver failure, nephrotic syndrome, protein-losing enteropathy, malignancy.", BODY)],
    [Paragraph("Fluid thrill", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Tense ascites (large volume). One hand on flank, assistant's hand on midline to prevent fat conduction, tap opposite flank.", BODY)],
    [Paragraph("Renal angle percussion (CVA tenderness)", BOLD),
     Paragraph("Non-tender", BODY),
     Paragraph("Positive (pain on fist percussion over costovertebral angle) = pyelonephritis, renal calculi. UTI commonly mimics abdominal pain in children.", BODY)],
    [Paragraph("Percuss for bladder", BOLD),
     Paragraph("Dull only if distended", BODY),
     Paragraph("Suprapubic dullness = urinary retention (uncommon in children but seen post-surgery, with neurogenic bladder).", BODY)],
]
story.append(make_table(perc_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 5: SPECIAL / ELICITED SIGNS
# ═══════════════════════════════════════════════════════════════
story.append(section_header("5. SPECIAL SIGNS  (Elicited Tests)"))
story.append(Spacer(1, 1*mm))

spec_hdr = [Paragraph(f"<b>{l}</b>", S("sh", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold"))
            for l in ["Sign", "How to Elicit", "Positive Finding / Significance"]]

spec_rows = [
    [Paragraph("Rebound tenderness\n(Blumberg's sign)", BOLD),
     Paragraph("Press slowly and firmly, then release suddenly. Alternatively: percussion tenderness (gentler, preferred in children).", BODY),
     Paragraph("Pain worse on RELEASE than press = peritoneal irritation. Appendicitis, perforated viscus. Percussion tenderness = same significance, less distressing for child.", BODY)],
    [Paragraph("Rovsing's sign", BOLD),
     Paragraph("Press LIF (left iliac fossa) while watching/asking about RIF pain.", BODY),
     Paragraph("Positive = pain in RIF when LIF compressed = appendicitis (referred peritoneal irritation from right side).", BODY)],
    [Paragraph("Psoas sign", BOLD),
     Paragraph("Child lies on left side. Extend right hip passively (or ask child to raise right leg against resistance).", BODY),
     Paragraph("Positive = pain in RIF = retrocaecal appendix (lying on psoas muscle). Also positive in right-sided psoas abscess.", BODY)],
    [Paragraph("Obturator sign", BOLD),
     Paragraph("Flex and internally rotate right hip (with knee flexed).", BODY),
     Paragraph("Positive = RIF pain = pelvic appendix or pelvic abscess (appendix lies near obturator internus).", BODY)],
    [Paragraph("Heel-drop test\n(Markle's sign)", BOLD),
     Paragraph("Ask child to stand on tiptoe then drop onto heels (or lower child firmly onto heels).", BODY),
     Paragraph("Pain on heel strike = peritoneal irritation. Sensitive, non-invasive, child-friendly alternative to rebound tenderness.", BODY)],
    [Paragraph("Carnett's sign", BOLD),
     Paragraph("Locate tender area. Ask child to tense abdomen (lift head or legs). Palpate same area.", BODY),
     Paragraph("Pain UNCHANGED or WORSE with tensed muscles = abdominal wall pain (not visceral). Pain improves = intra-abdominal cause.", BODY)],
    [Paragraph("Murphy's sign", BOLD),
     Paragraph("Deep palpation in RUQ. Ask child to breathe in deeply.", BODY),
     Paragraph("Positive = sudden inspiration arrest due to pain = cholecystitis (gallbladder descends onto examining hand). Uncommon in children but seen in sickle cell, CF.", BODY)],
    [Paragraph("Dance's sign", BOLD),
     Paragraph("Palpate right iliac fossa.", BODY),
     Paragraph("Empty RIF (absent bowel gas/loops) = intussusception (bowel telescoped away from RIF). Paired with sausage-shaped mass elsewhere.", BODY)],
    [Paragraph("Cullen's sign / Grey Turner's sign", BOLD),
     Paragraph("Inspect periumbilical (Cullen's) and flank (Grey Turner's) skin.", BODY),
     Paragraph("Bruising = retroperitoneal haemorrhage = severe pancreatitis, ruptured AAA (rare in children, but pancreatitis occurs).", BODY)],
    [Paragraph("Succussion splash", BOLD),
     Paragraph("Hands on sides of abdomen, shake patient side-to-side. Listen with stethoscope or unaided.", BODY),
     Paragraph("Audible splash = fluid + air in obstructed hollow viscus. Gastric outlet obstruction (pyloric stenosis, antral pathology).", BODY)],
]
story.append(make_table(spec_rows, col_widths=[5*cm, 6*cm, 7.5*cm], header_row=spec_hdr))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 6: HERNIAL ORIFICES & GENITALIA
# ═══════════════════════════════════════════════════════════════
story.append(section_header("6. HERNIAL ORIFICES, GENITALIA & RECTUM"))
story.append(Spacer(1, 1*mm))

hern_rows = [
    [Paragraph("Inguinal hernias", BOLD),
     Paragraph("No bulge at rest or on coughing/crying", BODY),
     Paragraph("Indirect inguinal hernia most common in boys <1 year. Risk of incarceration = strangulation = obstruction. ALWAYS examine groin in child with vomiting.", BODY)],
    [Paragraph("Umbilical hernia", BOLD),
     Paragraph("No persistent defect in school-age (usually closes by age 5)", BODY),
     Paragraph("Persistent in >5 years = consider repair. Incarceration rare. More common in African children and premature infants.", BODY)],
    [Paragraph("Femoral hernia", BOLD),
     Paragraph("Absent", BODY),
     Paragraph("Rare in children. Below and lateral to pubic tubercle. Higher incarceration risk than inguinal hernias.", BODY)],
    [Paragraph("Testes (males)", BOLD),
     Paragraph("Both testes palpable in scrotum bilaterally", BODY),
     Paragraph("Undescended = orchidopexy needed by age 1. Testicular torsion = sudden severe scrotal pain, absent cremasteric reflex, high-riding testis. Presents as abdominal pain - ALWAYS examine scrotum in boys with abdominal pain.", BODY)],
    [Paragraph("Cremasteric reflex", BOLD),
     Paragraph("Present (stroking medial thigh raises ipsilateral testis)", BODY),
     Paragraph("Absent in testicular torsion. Sensitive test - if absent, urgent surgical exploration needed.", BODY)],
    [Paragraph("Perianal inspection", BOLD),
     Paragraph("Intact skin, no fissures, normal tone", BODY),
     Paragraph("Anal fissure = most common cause of rectal bleeding in infants/toddlers (hard stool + pain + surface blood). Skin tags = Crohn's. Warts = consider abuse. Patulous anus = neurological cause of constipation.", BODY)],
    [Paragraph("Digital Rectal Examination\n(in children: consider carefully, only if indicated)", BOLD),
     Paragraph("Performed only when clinically necessary with consent/assent", BODY),
     Paragraph("Empty rectum in constipated child = high impaction (Hirschsprung's). Hard stool = functional constipation. Blood on glove = colitis. Tender anteriorly = pelvic appendicitis/abscess. Not routinely needed for appendicitis diagnosis (evidence does not support diagnostic utility).", BODY)],
]
story.append(make_table(hern_rows, col_widths=COL_W, header_row=hdr))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 7: EXTRA-INTESTINAL MANIFESTATIONS
# ═══════════════════════════════════════════════════════════════
story.append(section_header("7. EXTRA-INTESTINAL MANIFESTATIONS  (Examine These in Every GI Case)"))
story.append(Spacer(1, 1*mm))

ext_rows = [
    [Paragraph("Skin: erythema nodosum", BOLD),
     Paragraph("Painful red nodules on shins/extensors", BODY),
     Paragraph("IBD (Crohn's > UC), sarcoidosis, Behcet's. Signals systemic inflammation.", BODY)],
    [Paragraph("Skin: pyoderma gangrenosum", BOLD),
     Paragraph("Necrotic ulcers with violaceous edge", BODY),
     Paragraph("IBD (UC > Crohn's). Pathergy present. Indicates severe/active disease.", BODY)],
    [Paragraph("Skin: dermatitis herpetiformis", BOLD),
     Paragraph("Itchy vesicular rash elbows, knees, buttocks", BODY),
     Paragraph("Gluten sensitivity = coeliac disease. Nearly pathognomonic.", BODY)],
    [Paragraph("Skin: jaundice (sclera first)", BOLD),
     Paragraph("Yellow discolouration sclera → skin", BODY),
     Paragraph("Pre-hepatic (haemolysis), hepatic (hepatitis, Wilson's, metabolic), post-hepatic (biliary atresia, choledochal cyst).", BODY)],
    [Paragraph("Joints: arthritis/arthralgia", BOLD),
     Paragraph("Swollen, warm, tender joints", BODY),
     Paragraph("IBD (peripheral arthritis - large joints, parallels bowel activity). Reactive arthritis post-GI infection (Salmonella, Campylobacter, Yersinia).", BODY)],
    [Paragraph("Eyes: uveitis / episcleritis", BOLD),
     Paragraph("Red, painful eye; photophobia", BODY),
     Paragraph("IBD extra-intestinal manifestation. Uveitis can cause blindness if untreated - always refer ophthalmology.", BODY)],
    [Paragraph("Mouth: angular cheilitis, glossitis", BOLD),
     Paragraph("Inflamed lip angles; smooth red tongue", BODY),
     Paragraph("Nutritional deficiency (iron, B12, folate, B2) = coeliac, IBD, chronic malabsorption.", BODY)],
    [Paragraph("Growth: height, weight, puberty stage", BOLD),
     Paragraph("Appropriate for age on growth chart", BODY),
     Paragraph("Delayed growth/puberty = classic in Crohn's disease. Can be presenting sign before bowel symptoms. Always plot and compare to previous measurements.", BODY)],
]
story.append(make_table(ext_rows, col_widths=[5.5*cm, 5.5*cm, 7.5*cm], header_row=[
    Paragraph("<b>Manifestation</b>", S("h", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold")),
    Paragraph("<b>What You See</b>", S("h", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold")),
    Paragraph("<b>Significance / Diagnosis</b>", S("h", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold")),
]))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 8: DEHYDRATION ASSESSMENT
# ═══════════════════════════════════════════════════════════════
story.append(section_header("8. DEHYDRATION ASSESSMENT  (Critical in Paediatric GI)"))
story.append(Spacer(1, 1*mm))

dehyd_hdr = [Paragraph(f"<b>{l}</b>", S("dh", fontSize=8, textColor=GREY_DARK, fontName="Helvetica-Bold"))
             for l in ["Clinical Sign", "Mild (<5%)", "Moderate (5-10%)", "Severe (>10%)"]]

dehyd_rows = [
    [Paragraph("General appearance", BODY),
     Paragraph("Alert, normal", BODY),
     Paragraph("Restless, irritable", BODY),
     Paragraph("Lethargic, limp, unresponsive", BODY)],
    [Paragraph("Eyes", BODY),
     Paragraph("Normal", BODY),
     Paragraph("Slightly sunken", BODY),
     Paragraph("Deeply sunken, no tears", BODY)],
    [Paragraph("Mucous membranes", BODY),
     Paragraph("Moist", BODY),
     Paragraph("Dry", BODY),
     Paragraph("Parched, cracked", BODY)],
    [Paragraph("Skin turgor\n(pinch abdomen/thigh)", BODY),
     Paragraph("Returns instantly", BODY),
     Paragraph("Returns slowly (1-2 sec)", BODY),
     Paragraph("Returns very slowly (>2 sec) or stays tented", BODY)],
    [Paragraph("Capillary refill", BODY),
     Paragraph("<2 sec", BODY),
     Paragraph("2-3 sec", BODY),
     Paragraph(">3 sec", BODY)],
    [Paragraph("Heart rate", BODY),
     Paragraph("Normal", BODY),
     Paragraph("Mildly elevated", BODY),
     Paragraph("Significantly elevated", BODY)],
    [Paragraph("Blood pressure", BODY),
     Paragraph("Normal", BODY),
     Paragraph("Normal or slightly low", BODY),
     Paragraph("Hypotensive, undetectable", BODY)],
    [Paragraph("Urine output", BODY),
     Paragraph("Normal", BODY),
     Paragraph("Reduced, concentrated", BODY),
     Paragraph("Oliguric/anuric", BODY)],
    [Paragraph("Fontanelle (infants)", BODY),
     Paragraph("Flat", BODY),
     Paragraph("Slightly sunken", BODY),
     Paragraph("Markedly sunken", BODY)],
    [Paragraph("MANAGEMENT", RED),
     Paragraph("Oral rehydration\nsolution (ORS)", BODY),
     Paragraph("ORS 50-100 mL/kg\nover 2-4 hours", BODY),
     Paragraph("IV fluids STAT\n20 mL/kg 0.9% NaCl bolus\nRepeat as needed", BODY)],
]
dt = Table([dehyd_hdr] + dehyd_rows, colWidths=[5*cm, 4*cm, 4.5*cm, 5*cm], repeatRows=1)
dstyle = [
    ("FONTNAME",(0,0),(-1,-1),"Helvetica"),
    ("FONTSIZE",(0,0),(-1,-1),8.5),
    ("LEADING",(0,0),(-1,-1),11),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
    ("TOPPADDING",(0,0),(-1,-1),4),
    ("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("GRID",(0,0),(-1,-1),0.25,HexColor("#CFD8DC")),
    ("BACKGROUND",(0,0),(-1,0),TEAL_MID),
    ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold"),
    ("FONTSIZE",(0,0),(-1,0),8),
    # Colour severity columns
    ("BACKGROUND",(1,1),  (1,-1), HexColor("#F1F8E9")),
    ("BACKGROUND",(2,1),  (2,-1), HexColor("#FFF9C4")),
    ("BACKGROUND",(3,1),  (3,-1), HexColor("#FFEBEE")),
    # Last row (management) - bold
    ("FONTNAME",(0,-1),(-1,-1),"Helvetica-Bold"),
    ("BACKGROUND",(0,-1),(-1,-1), HexColor("#E8EAF6")),
]
dt.setStyle(TableStyle(dstyle))
story.append(dt)
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 9: RED FLAG SIGNS
# ═══════════════════════════════════════════════════════════════
story.append(section_header("9. RED FLAG SIGNS  (Require Immediate Action)", color=ORANGE))
story.append(Spacer(1, 1*mm))

rf_rows = [
    [Paragraph("Bilious (green) vomiting", RED),
     Paragraph("Inspect vomitus / ask specifically. Green colour confirms bile.", BODY),
     Paragraph("Bowel obstruction DISTAL to ampulla of Vater. In neonate = malrotation + volvulus (life-threatening). Surgical emergency until proven otherwise.", BODY)],
    [Paragraph("Board-like rigidity", RED),
     Paragraph("Involuntary muscle contraction persists despite distraction.", BODY),
     Paragraph("Peritonitis = perforation until proven otherwise. Immediate surgical referral + resuscitation.", BODY)],
    [Paragraph("Absent bowel sounds (>2 min)", RED),
     Paragraph("Auscultate all four quadrants for minimum 2 minutes.", BODY),
     Paragraph("Paralytic ileus (peritonitis, post-perforation, severe electrolyte disturbance). Or mechanical obstruction (late).", BODY)],
    [Paragraph("Loss of liver dullness", RED),
     Paragraph("Percussion over liver area - resonant instead of dull.", BODY),
     Paragraph("Pneumoperitoneum = air under diaphragm = perforated viscus. Confirm with erect CXR (free air under diaphragm).", BODY)],
    [Paragraph("Positive heel-drop / rebound", RED),
     Paragraph("Pain on heel strike or release of pressure.", BODY),
     Paragraph("Peritoneal irritation = appendicitis, perforated viscus, ruptured ectopic (adolescent girls).", BODY)],
    [Paragraph("Palpable RIF mass + colicky pain + currant-jelly stool", RED),
     Paragraph("Sausage-shaped mass in RUQ/transverse + empty RIF (Dance's sign).", BODY),
     Paragraph("Intussusception. Peak age 3 months - 3 years. Urgent USS + pneumatic or hydrostatic reduction.", BODY)],
    [Paragraph("Absent cremasteric reflex in boys", RED),
     Paragraph("Stroke medial thigh - no testicular elevation.", BODY),
     Paragraph("Testicular torsion until proven otherwise. 6-hour window for salvage. Urgent surgical exploration - do NOT await USS.", BODY)],
    [Paragraph("Severe dehydration signs", RED),
     Paragraph("Sunken eyes, no tears, skin tenting, CRT >3 sec, altered consciousness.", BODY),
     Paragraph("Hypovolaemic shock. IV bolus 20 mL/kg 0.9% NaCl immediately. Reassess and repeat. ICU escalation if no response.", BODY)],
    [Paragraph("Haematemesis / large PR bleed", RED),
     Paragraph("Fresh blood or coffee grounds in vomit / significant rectal blood.", BODY),
     Paragraph("Active GI haemorrhage. IV access, crossmatch, surgical + GI endoscopy team. Proton pump inhibitor if upper GI source likely.", BODY)],
]
story.append(red_flag_table(rf_rows))
story.append(Spacer(1, 3*mm))

# ═══════════════════════════════════════════════════════════════
# SECTION 10: EXAMINATION SUMMARY CHECKLIST
# ═══════════════════════════════════════════════════════════════
story.append(section_header("10. EXAMINATION SUMMARY CHECKLIST  (Quick-Reference Tick List)"))
story.append(Spacer(1, 1*mm))

check_items = [
    ("GENERAL", [
        "Child appearance (comfortable / distressed / peritonitic posture)",
        "Nutritional status (weight on centile chart)",
        "Skin colour (jaundice / pallor / perfusion)",
        "Vital signs all documented with age-referenced ranges",
    ]),
    ("PERIPHERAL", [
        "Hands: clubbing, koilonychia, leuconychia, palmar erythema",
        "Eyes: scleral icterus, conjunctival pallor, sunken eyes",
        "Mouth: mucous membrane moisture, ulcers, glossitis, dental erosions",
        "Neck: lymphadenopathy",
    ]),
    ("ABDOMEN - INSPECTION", [
        "Shape (distension / scaphoid / asymmetry)",
        "Visible peristalsis (especially infants)",
        "Umbilicus (central / everted / displaced)",
        "Skin (scars / caput medusae / striae)",
        "Movement with respiration (free / restricted)",
    ]),
    ("ABDOMEN - AUSCULTATION", [
        "Bowel sounds (normal / absent / high-pitched / tinkling)",
        "Succussion splash if gastric outlet obstruction suspected",
    ]),
    ("ABDOMEN - PALPATION", [
        "Systematic 9-quadrant or 4-quadrant light palpation (start away from pain)",
        "Deep palpation: tenderness site and character",
        "Liver: size, edge character, tenderness",
        "Spleen: size, direction of enlargement",
        "Kidneys: ballottement bilaterally",
        "Faecal mass / abnormal mass",
    ]),
    ("ABDOMEN - PERCUSSION", [
        "Liver dullness and span",
        "Splenic dullness (Traube's space)",
        "Shifting dullness (ascites)",
        "Renal angle tenderness",
    ]),
    ("SPECIAL SIGNS", [
        "Rebound / percussion tenderness (if peritonism suspected)",
        "Rovsing's sign (appendicitis)",
        "Heel-drop test (peritoneal irritation)",
        "Carnett's sign (if abdominal wall pain considered)",
    ]),
    ("HERNIAS / GENITALIA", [
        "Inguinal orifices (bilateral)",
        "Testes palpated bilaterally (males) - cremasteric reflex",
        "Perianal inspection (fissure, skin tags, warts)",
    ]),
    ("EXTRA-INTESTINAL", [
        "Skin rashes (erythema nodosum, pyoderma gangrenosum, dermatitis herpetiformis)",
        "Joints examined if arthralgia reported",
        "Growth: height and weight plotted on centile chart",
    ]),
]

for section_name, items in check_items:
    check_data = []
    check_data.append([
        Paragraph(f"<b>{section_name}</b>",
                  S("cl", fontSize=8, textColor=TEAL, fontName="Helvetica-Bold")),
        Paragraph("", BODY)
    ])
    for item in items:
        check_data.append([
            Paragraph("☐  " + item, BODY),
            Paragraph("", BODY)
        ])

    ct = Table(check_data, colWidths=[PAGE_W - 36*mm - 3*cm, 3*cm])
    cstyle = [
        ("FONTNAME",(0,0),(-1,-1),"Helvetica"),
        ("FONTSIZE",(0,0),(-1,-1),8.5),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
        ("TOPPADDING",(0,0),(-1,-1),3),
        ("BOTTOMPADDING",(0,0),(-1,-1),3),
        ("LEFTPADDING",(0,0),(-1,-1),5),
        ("BACKGROUND",(0,0),(-1,0), TEAL_LIGHT),
        ("GRID",(0,0),(-1,-1),0.2,HexColor("#CFD8DC")),
    ]
    for i in range(1, len(check_data)):
        bg = GREY_LIGHT if i%2==1 else WHITE
        cstyle.append(("BACKGROUND",(0,i),(-1,i),bg))
    ct.setStyle(TableStyle(cstyle))
    story.append(ct)
    story.append(Spacer(1, 1.5*mm))

story.append(Spacer(1, 3*mm))

# ── FOOTER NOTE ──
story.append(HRFlowable(width="100%", thickness=0.5, color=TEAL))
story.append(Spacer(1, 2*mm))
fn = Table([[
    Paragraph("Sources: Tintinalli's Emergency Medicine (Vomiting, Diarrhea & Dehydration in Children); "
              "Bailey & Love's Short Practice of Surgery 28e (Clinical Signs in Appendicitis); "
              "Textbook of Family Medicine 9e (Common Paediatric GI Disorders). "
              "For educational/study use. Always apply clinical judgement.",
              S("fn", fontSize=7, leading=10, textColor=GREY_DARK, fontName="Helvetica-Oblique"))
]], colWidths=[PAGE_W - 36*mm])
fn.setStyle(TableStyle([
    ("LEFTPADDING",(0,0),(-1,-1),0),
    ("TOPPADDING",(0,0),(-1,-1),0),
]))
story.append(fn)

# ── BUILD ────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=18*mm,
    rightMargin=18*mm,
    topMargin=28*mm,
    bottomMargin=14*mm,
    title="Pediatric GI Examination Schema",
    author="Orris Medical Notes",
    subject="Paediatric GI Physical Examination",
)

doc.build(story, onFirstPage=add_header_footer, onLaterPages=add_header_footer)
print(f"PDF generated: {OUTPUT}")