gastric volvulus organoaxial mesenteroaxial diagram

perforated peptic ulcer pneumoperitoneum X-ray free air under diaphragm

ls -la /tmp/workspace/ 2>/dev/null || mkdir -p /tmp/workspace && echo "created"

mkdir -p /tmp/workspace/gastric-surgery && cat > /tmp/workspace/gastric-surgery/make_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm, mm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, KeepTogether) from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import PageBreak OUTPUT = "/tmp/workspace/gastric-surgery/Gastric_Volvulus_Perforation_UHS.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, leftMargin=2*cm, rightMargin=2*cm, topMargin=2*cm, bottomMargin=2*cm, title="Gastric Volvulus & Perforation - UHS MBBS Final Year", author="Orris Medical" ) # ── Colour palette ────────────────────────────────────────────────────────── DARK_BLUE = colors.HexColor("#1a3a5c") MED_BLUE = colors.HexColor("#2563a8") LIGHT_BLUE = colors.HexColor("#dbeafe") ACCENT_RED = colors.HexColor("#b91c1c") ACCENT_YEL = colors.HexColor("#fef9c3") HEADER_BG = colors.HexColor("#1e3a5f") TABLE_HDR = colors.HexColor("#2563a8") TABLE_ALT = colors.HexColor("#f0f6ff") WHITE = colors.white LIGHT_GRAY = colors.HexColor("#f8f9fa") DARK_GRAY = colors.HexColor("#374151") styles = getSampleStyleSheet() # ── Custom styles ──────────────────────────────────────────────────────────── def S(name, **kw): return ParagraphStyle(name, **kw) title_style = S("MainTitle", fontSize=18, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=4, leading=22) subtitle_style = S("SubTitle", fontSize=11, textColor=colors.HexColor("#bfdbfe"), fontName="Helvetica", alignment=TA_CENTER, spaceAfter=2) part_style = S("PartHeader", fontSize=14, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=2, spaceBefore=4, leading=18) h1 = S("H1", fontSize=12, textColor=DARK_BLUE, fontName="Helvetica-Bold", spaceBefore=10, spaceAfter=4, leading=15, borderPad=4, leftIndent=0) h2 = S("H2", fontSize=10.5, textColor=MED_BLUE, fontName="Helvetica-Bold", spaceBefore=6, spaceAfter=3, leading=13) body = S("Body", fontSize=9.5, textColor=DARK_GRAY, fontName="Helvetica", spaceBefore=2, spaceAfter=2, leading=13, alignment=TA_JUSTIFY) bullet = S("Bullet", fontSize=9.5, textColor=DARK_GRAY, fontName="Helvetica", spaceBefore=1, spaceAfter=1, leading=12, leftIndent=14, firstLineIndent=-10) note_style = S("Note", fontSize=9, textColor=colors.HexColor("#1e3a5f"), fontName="Helvetica-BoldOblique", spaceBefore=3, spaceAfter=3, leading=12, backColor=ACCENT_YEL, borderPad=5, leftIndent=6) keybox = S("KeyBox", fontSize=9, textColor=colors.HexColor("#7f1d1d"), fontName="Helvetica-Bold", spaceBefore=2, spaceAfter=2, leading=12, backColor=colors.HexColor("#fee2e2"), borderPad=5, leftIndent=6) small = S("Small", fontSize=8.5, textColor=colors.HexColor("#6b7280"), fontName="Helvetica", spaceBefore=1, spaceAfter=1, leading=11) # ── Helpers ────────────────────────────────────────────────────────────────── def hr(color=MED_BLUE, w=1): return HRFlowable(width="100%", thickness=w, color=color, spaceAfter=4, spaceBefore=2) def title_banner(text, sub=""): banner_data = [[Paragraph(text, title_style)]] if sub: banner_data.append([Paragraph(sub, subtitle_style)]) t = Table(banner_data, colWidths=["100%"]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), HEADER_BG), ("ROUNDEDCORNERS", [6]), ("TOPPADDING", (0,0), (-1,-1), 10), ("BOTTOMPADDING", (0,0), (-1,-1), 10), ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8), ])) return t def part_banner(text): t = Table([[Paragraph(text, part_style)]], colWidths=["100%"]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), MED_BLUE), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8), ])) return t def make_table(headers, rows, col_widths=None): """Build a styled table.""" hdr_style = ParagraphStyle("TH", fontSize=9, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=11, spaceAfter=0, spaceBefore=0) cell_style = ParagraphStyle("TD", fontSize=9, textColor=DARK_GRAY, fontName="Helvetica", alignment=TA_LEFT, leading=11, spaceAfter=0, spaceBefore=0) header_row = [Paragraph(h, hdr_style) for h in headers] data = [header_row] for i, row in enumerate(rows): data.append([Paragraph(str(c), cell_style) for c in row]) avail = 17*cm # usable width if col_widths is None: w = avail / len(headers) col_widths = [w]*len(headers) t = Table(data, colWidths=col_widths, repeatRows=1) style_cmds = [ ("BACKGROUND", (0,0), (-1,0), TABLE_HDR), ("TEXTCOLOR", (0,0), (-1,0), WHITE), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 9), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#94a3b8")), ("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), ] for i in range(1, len(data)): bg = TABLE_ALT if i % 2 == 0 else WHITE style_cmds.append(("BACKGROUND", (0,i), (-1,i), bg)) t.setStyle(TableStyle(style_cmds)) return t def b(text): return Paragraph(f"<b>•</b> {text}", bullet) def bb(label, text): return Paragraph(f"<b>• {label}:</b> {text}", bullet) # ═══════════════════════════════════════════════════════════════════════════ # BUILD STORY # ═══════════════════════════════════════════════════════════════════════════ story = [] # ── TITLE ──────────────────────────────────────────────────────────────────── story.append(title_banner( "GASTRIC VOLVULUS &amp; PERFORATION", "UHS MBBS Final Year | Surgery | Standard Answer Pattern" )) story.append(Spacer(1, 6)) # ══════════════════════════════════════════════════════════════════════════════ # PART 1 — GASTRIC VOLVULUS # ══════════════════════════════════════════════════════════════════════════════ story.append(part_banner("PART 1: GASTRIC VOLVULUS")) story.append(Spacer(1, 4)) # Definition story.append(Paragraph("1. DEFINITION", h1)) story.append(hr()) story.append(Paragraph( "Gastric volvulus is a rare but life-threatening condition in which the stomach " "rotates <b>more than 180° on its own axis</b>, leading to obstruction, strangulation, " "ischemia, and infarction - either intra-abdominally or intrathoracically. " "First described by Berti (1866); first surgical treatment 1897.", body)) story.append(Spacer(1, 4)) # Classification story.append(Paragraph("2. CLASSIFICATION (Singleton's)", h1)) story.append(hr()) cls_table = make_table( ["Type", "Axis of Rotation", "Freq.", "Key Features"], [ ["Type I\nOrganoaxial", "Long longitudinal axis\n(GEJ → Pylorus)", "59%", "Stomach flips anteriorly; closed-loop obstruction; strangulation in 28%"], ["Type II\nMesenteroaxial", "Short transgastric axis\n(lesser ↔ greater curvature)", "29%", "Stomach folds on itself; usually incomplete & intermittent; infarction uncommon"], ["Type III\nCombined", "Both axes", "12%", "Usually chronic cases"], ], col_widths=[3.2*cm, 4.2*cm, 1.5*cm, 8.1*cm] ) story.append(cls_table) story.append(Spacer(1, 4)) # Etiology story.append(Paragraph("3. ETIOLOGY", h1)) story.append(hr()) story.append(Paragraph("<b>A) Primary</b> - Laxity/abnormality of gastric ligaments:", h2)) story.append(b("Gastrocolic, gastrohepatic, gastrosplenic, gastrophrenic ligaments")) story.append(Paragraph("<b>B) Secondary</b> - Due to anatomic defects:", h2)) story.append(bb("Most common (adults)", "Paraesophageal hernia")) story.append(bb("Children (&lt;1 yr)", "Congenital diaphragmatic defects (Foramen of Bochdalek, diaphragmatic eventration) - 10-20% of pediatric cases")) story.append(bb("Others", "Prior gastric surgery, neoplasia, connective tissue disorders")) story.append(Paragraph( "<b>Epidemiology:</b> Peak incidence in the 6th decade; men = women equally.", note_style)) story.append(Spacer(1, 4)) # Clinical Presentation story.append(Paragraph("4. CLINICAL PRESENTATION", h1)) story.append(hr()) story.append(Paragraph("<b>A) ACUTE GASTRIC VOLVULUS</b>", h2)) story.append(Paragraph( "<b>Borchardt's Triad</b> (present in ~70% of acute cases):", body)) tri_table = make_table( ["No.", "Feature", "Explanation"], [ ["1", "Acute-onset severe epigastric / substernal pain", "Radiates to neck & shoulders; mimics MI"], ["2", "Violent retching with minimal/no vomiting", "Dry heaving due to closed-loop obstruction"], ["3", "Inability to pass NG tube into stomach", "Indicates complete volvulus"], ], col_widths=[1.2*cm, 7.5*cm, 8.3*cm] ) story.append(tri_table) story.append(Spacer(1, 3)) story.append(b("Upper abdominal distension and tenderness")) story.append(b("Hematemesis = ominous sign of mucosal ischemia; may progress to hypovolemic shock")) story.append(b("Multi-organ failure in advanced cases")) story.append(Spacer(1, 4)) story.append(Paragraph("<b>B) CHRONIC GASTRIC VOLVULUS</b>", h2)) story.append(b("Intermittent vague upper abdominal symptoms for years")) story.append(b("Pyrosis, early satiety, bloating, shortness of breath, burping")) story.append(b("Symptoms worsen with large meals; vomiting may relieve discomfort")) story.append(b("Often diagnosed incidentally or during workup for PUD / MI / cholecystitis")) story.append(Paragraph("<b>Mortality:</b> &lt;13% in chronic form vs 15-20% in acute form.", note_style)) story.append(Spacer(1, 4)) # Diagnosis story.append(Paragraph("5. DIAGNOSIS", h1)) story.append(hr()) story.append(Paragraph("<b>A) Plain X-ray (Erect Chest + Abdomen):</b>", h2)) story.append(b("Spherical gas-filled viscus in chest or upper abdomen (retrocardiac position)")) story.append(b("Air-fluid level within the viscus")) story.append(b("Paucity of air in rest of GI tract")) story.append(b('"Upside-down stomach" - greater curvature above lesser curvature')) story.append(b("In mesenteroaxial: spherical stomach on supine film")) story.append(Paragraph("<b>B) CT Scan (Investigation of Choice):</b>", h2)) story.append(b("<b>Swirl sign</b> of esophagus and stomach (pathognomonic)")) story.append(b("Dilated, distended stomach")) story.append(b("Pneumatosis (gastric wall air) = necrosis; Free air = perforation")) story.append(b("Identifies associated defects (paraesophageal hernia)")) story.append(b("Excludes other diagnoses")) story.append(Paragraph("<b>C) Contrast Study (Barium/Water-Soluble):</b>", h2)) story.append(b('"Beaking" / torsion at rotation point; no passage of contrast into duodenum')) story.append(Spacer(1, 4)) # Surgical Management - Volvulus story.append(Paragraph("6. SURGICAL MANAGEMENT", h1)) story.append(hr()) story.append(Paragraph("<b>Step 1 - Initial Resuscitation (ALL patients):</b>", h2)) story.append(b("IV fluids + electrolyte correction")) story.append(b("Analgesics and antiemetics")) story.append(b("Attempted NG tube decompression (may spontaneously detorse)")) story.append(b("If NG fails: Endoscopic decompression (limit insufflation, assess mucosa, place NG)")) story.append(Spacer(1, 3)) story.append(Paragraph("<b>Step 2 - Indications for Immediate Surgery:</b>", h2)) story.append(b("Failed NG / endoscopic decompression")) story.append(b("Gastric perforation")) story.append(b("Severe sepsis or refractory hypotension")) story.append(b("Signs of gastric ischemia / necrosis")) story.append(Spacer(1, 3)) story.append(Paragraph("<b>Step 3 - Operative Management:</b>", h2)) op_table = make_table( ["Patient Status", "Approach", "Procedure"], [ ["Unstable", "Urgent open laparotomy", "Detorse stomach → assess viability → resect ischemic areas\nIf entire stomach necrotic: total gastrectomy + jejunostomy + esophagostomy (reconstruction later)"], ["Stable - Primary volvulus", "Open or laparoscopic", "Suture gastropexy to anterior abdominal wall ± gastrostomy tube"], ["Stable - Secondary (PEH)", "Open or laparoscopic", "Repair paraesophageal hernia + reduce hernia sac + mobilize distal esophagus + fundoplication"], ["High surgical risk", "Endoscopic", "Endoscopic detorsion + 2 PEG tubes for fixation (prevents re-rotation)"], ], col_widths=[3.5*cm, 4.5*cm, 9*cm] ) story.append(op_table) story.append(Spacer(1, 6)) # ══════════════════════════════════════════════════════════════════════════════ # PAGE BREAK before Part 2 # ══════════════════════════════════════════════════════════════════════════════ story.append(PageBreak()) # ══════════════════════════════════════════════════════════════════════════════ # PART 2 — GASTRIC PERFORATION # ══════════════════════════════════════════════════════════════════════════════ story.append(part_banner("PART 2: GASTRIC PERFORATION")) story.append(Spacer(1, 4)) # Definition story.append(Paragraph("1. DEFINITION", h1)) story.append(hr()) story.append(Paragraph( "Gastric perforation is a <b>full-thickness breach of the gastric wall</b> allowing " "gastric contents to escape into the peritoneal cavity, most commonly due to peptic ulcer disease.", body)) story.append(Spacer(1, 4)) # Etiology story.append(Paragraph("2. ETIOLOGY", h1)) story.append(hr()) et_table = make_table( ["Category", "Details"], [ ["Peptic ulcer disease (MC)", "H. pylori, NSAIDs; DU > GU; ~20% of perforations are GU"], ["Malignancy", "~6% of perforated GUs are malignant (gastric carcinoma)"], ["Gastric volvulus", "Ischemia → necrosis → perforation"], ["Trauma", "Blunt / penetrating abdominal trauma"], ["Iatrogenic", "Endoscopy, NG tube, surgical injury"], ["Corrosives", "Acid / alkali ingestion"], ["Stress ulcers", "Burns (Curling's ulcer), Head injury (Cushing's ulcer)"], ["Foreign body", "Ingested sharp objects"], ], col_widths=[5*cm, 12*cm] ) story.append(et_table) story.append(Spacer(1, 4)) # Clinical Presentation story.append(Paragraph("3. CLINICAL PRESENTATION", h1)) story.append(hr()) story.append(Paragraph("<b>A) Symptoms:</b>", h2)) story.append(b("<b>Sudden-onset severe epigastric pain</b> (knife-like) - rapidly becomes generalized")) story.append(b("Nausea and vomiting")) story.append(b("History: PUD, NSAID / steroid use, smoking")) story.append(Paragraph("<b>B) Signs:</b>", h2)) story.append(b("Patient lies still (peritonism worsens with movement)")) story.append(b("<b>Board-like rigidity</b> - hallmark of generalized peritonitis")) story.append(b("Guarding and rebound tenderness")) story.append(b("<b>Obliteration of liver dullness</b> on percussion (free air under diaphragm)")) story.append(b("Absent bowel sounds (paralytic ileus)")) story.append(b("Tachycardia, fever → later: septic shock")) story.append(Paragraph("<b>C) Three Stages of Progression:</b>", h2)) stage_table = make_table( ["Stage", "Timing", "Pathology", "Clinical Features"], [ ["1", "0-6 hours", "Chemical peritonitis", "Severe localized epigastric pain, rigidity"], ["2", "6-12 hours", "Dilution of chemical stimulus", "Relative improvement, patient may feel better"], ["3", ">12 hours", "Bacterial peritonitis", "Generalized sepsis, deterioration, shock"], ], col_widths=[1.5*cm, 2.5*cm, 4.5*cm, 8.5*cm] ) story.append(stage_table) story.append(Spacer(1, 4)) # Diagnosis - Perforation story.append(Paragraph("4. DIAGNOSIS", h1)) story.append(hr()) story.append(Paragraph("<b>A) Erect Chest X-ray / Upright Abdominal X-ray:</b>", h2)) story.append(b("<b>Free air (pneumoperitoneum) under diaphragm</b> - present in 70-80%")) story.append(b("Crescent-shaped radiolucency between liver and right dome of diaphragm (Cupola sign)")) story.append(b("Absent in ~20-30% cases - do not rule out perforation on negative X-ray")) story.append(Paragraph("<b>B) CT Scan Abdomen (most sensitive):</b>", h2)) story.append(b("Free intraperitoneal air and peritoneal fluid")) story.append(b("Localizes site of perforation")) story.append(b("Identifies associated pathology")) story.append(Paragraph("<b>C) Laboratory:</b>", h2)) story.append(b("Leukocytosis (WBC >10,000)")) story.append(b("Raised serum amylase (chemical peritonitis)")) story.append(b("ABG: Metabolic acidosis in advanced sepsis")) story.append(b("Raised creatinine in septic shock")) story.append(Spacer(1, 4)) # Surgical Management - Perforation story.append(Paragraph("5. SURGICAL MANAGEMENT", h1)) story.append(hr()) story.append(Paragraph("<b>A) Pre-operative Resuscitation (PULP Protocol):</b>", h2)) story.append(b("IV fluids - goal-directed fluid therapy")) story.append(b("IV broad-spectrum antibiotics (initiated immediately)")) story.append(b("NG tube (double-barreled) insertion + urinary catheter")) story.append(b("IV Proton Pump Inhibitor (PPI)")) story.append(b("Electrolyte correction; respiratory and circulatory support")) story.append(Paragraph( "<b>KEY:</b> Surgery within 6 hours → mortality 17%; without protocol → mortality 27% (Danish multicenter study, n=2619)", note_style)) story.append(Spacer(1, 4)) story.append(Paragraph("<b>B) Prognostic Scoring:</b>", h2)) boey_table = make_table( ["Boey Score (3 factors)", "PULP Score Variables"], [ ["1. Preoperative shock", "Age >65, Active malignancy, Cirrhosis, Glucocorticoid use"], ["2. Major medical illness (ASA >1)", "Perforation >24 hrs, Shock, Raised creatinine, ASA >1"], ["3. Perforation >12 hours", "AUROC = 0.83 for predicting mortality"], ], col_widths=[8.5*cm, 8.5*cm] ) story.append(boey_table) story.append(Spacer(1, 4)) story.append(Paragraph("<b>C) Operative Options:</b>", h2)) story.append(Paragraph("<b>For Perforated Duodenal Ulcer (DU) / Juxta-pyloric Ulcer:</b>", ParagraphStyle("h3", fontSize=9.5, textColor=DARK_BLUE, fontName="Helvetica-Bold", spaceBefore=4, spaceAfter=2, leading=12))) du_table = make_table( ["Procedure", "Indication"], [ ["Simple closure + <b>Graham Omental Patch</b>", "Most perforations; preferred for small to moderate size"], ["Laparoscopic repair", "Stable patients; small perforations (<10 mm); non-inferior to open repair " "(OR for septic complications 0.66, pulmonary complications 0.43)"], ["Open laparotomy", "Delayed presentation, shock, significant comorbidities, large perforations (>10 mm)"], ], col_widths=[6*cm, 11*cm] ) story.append(du_table) story.append(Spacer(1, 3)) story.append(Paragraph("<b>For Perforated Gastric Ulcer (GU):</b>", ParagraphStyle("h3b", fontSize=9.5, textColor=DARK_BLUE, fontName="Helvetica-Bold", spaceBefore=4, spaceAfter=2, leading=12))) gu_table = make_table( ["Location", "Procedure"], [ ["Small / prepyloric", "Simple closure with omental patch"], ["Angular notch (lesser curvature)", "Antrectomy + lesser curve ulcer excision + Billroth I or II reconstruction"], ["Large / suspected malignancy", "Gastric resection (distal gastrectomy)"], ], col_widths=[5*cm, 12*cm] ) story.append(gu_table) story.append(Paragraph( "<b>IMPORTANT:</b> ~6% of perforated GUs are malignant - always send tissue for biopsy.", keybox)) story.append(Spacer(1, 4)) story.append(Paragraph("<b>D) Post-operative Management:</b>", h2)) story.append(b("IV PPI + conversion to oral PPI")) story.append(b("<b>H. pylori eradication</b> if Hp-positive: reduces ulcer relapse from 38.1% → 4.8% at 1 year")) story.append(b("Continued IV antibiotics")) story.append(b("Nutritional support")) story.append(Spacer(1, 4)) story.append(Paragraph("<b>E) Complications:</b>", h2)) comp_table = make_table( ["Early", "Late"], [ ["Septic shock", "Adhesive intestinal obstruction"], ["Generalized peritonitis", "Re-operation (17% in large series)"], ["Intra-abdominal abscess", "Malnutrition / dumping syndrome"], ], col_widths=[8.5*cm, 8.5*cm] ) story.append(comp_table) story.append(Paragraph( "<b>Mortality:</b> 90-day mortality ~25.5% in large Danish series (726 patients, 2011-2013). " "Re-operation required in 17.1%; one-third due to persistent leaks.", note_style)) story.append(Spacer(1, 6)) # ══════════════════════════════════════════════════════════════════════════════ # SUMMARY TABLE # ══════════════════════════════════════════════════════════════════════════════ story.append(Paragraph("QUICK COMPARISON SUMMARY", h1)) story.append(hr(color=ACCENT_RED, w=1.5)) sum_table = make_table( ["Feature", "Gastric Volvulus", "Gastric Perforation"], [ ["Classic presentation", "Borchardt's Triad", "Sudden knife-like epigastric pain + peritonitis"], ["Key clinical sign", "Inability to pass NG tube", "Board-like rigidity + obliterated liver dullness"], ["Key investigation", "CT scan (Swirl sign)", "Erect CXR (free air under diaphragm)"], ["Emergency Rx", "NG decompression ± endoscopy", "IV fluids, antibiotics, NG tube, surgery within 6 hrs"], ["Definitive surgery", "Gastropexy / hernia repair", "Graham patch (DU) / Antrectomy (angular GU)"], ["Post-op essential", "Fixation prevents recurrence", "H. pylori eradication (relapse ↓ from 38% → 5%)"], ["Mortality", "15-20% (acute)", "~25.5% (90-day)"], ], col_widths=[4.5*cm, 6.25*cm, 6.25*cm] ) story.append(sum_table) story.append(Spacer(1, 6)) # ── KEY EXAM POINTS ───────────────────────────────────────────────────────── story.append(Paragraph( "★ KEY EXAM POINTS: Borchardt's triad for volvulus diagnosis | Swirl sign on CT | " "Boey score for perforation prognosis | Graham patch for DU perforation | " "Antrectomy for angular notch GU | Always biopsy perforated GU (6% malignant) | " "H. pylori eradication after repair | Surgery within 6 hrs reduces mortality", keybox)) story.append(Spacer(1, 4)) story.append(Paragraph( "Sources: Sabiston Textbook of Surgery | Yamada's Textbook of Gastroenterology | " "Sleisenger &amp; Fordtran's GI and Liver Disease", small)) # ── BUILD ──────────────────────────────────────────────────────────────────── doc.build(story) print(f"PDF created: {OUTPUT}") PYEOF echo "Script written successfully"

cd /tmp/workspace/gastric-surgery && python make_pdf.py

ls -lh /tmp/workspace/gastric-surgery/Gastric_Volvulus_Perforation_UHS.pdf