mkdir -p /home/daytona/workspace/small-intestine-ppt && ls /home/daytona/workspa…

~/small-intestine-ppt/create_pptx.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Disorders of the Small Intestine";
pres.author = "Medical Education";

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// ═══════════════════════════════════════════════════════════════
// SLIDE CONTENT
// ═══════════════════════════════════════════════════════════════

// ── 1. TITLE SLIDE ─────────────────────────────────────────────
titleSlide(
  "Disorders of the Small Intestine",
  "Clinical Features • Investigations • Principles of Management\nIncluding Short Gut Syndrome"
);

// ── 2. OVERVIEW ────────────────────────────────────────────────
contentSlide("Overview: Small Intestine Disorders", [
  { head: "Disorders Covered", subs: [
    "1. Malabsorption Syndrome",
    "2. Celiac Disease (Gluten-Sensitive Enteropathy)",
    "3. Tropical Sprue",
    "4. Crohn's Disease (Small Intestinal)",
    "5. Small Intestinal Obstruction",
    "6. Short Bowel / Short Gut Syndrome",
    "7. Small Intestinal Bacterial Overgrowth (SIBO)",
  ]},
  { head: "Learning Objectives", subs: [
    "Identify clinical features of each disorder",
    "Select appropriate investigations",
    "Apply principles of management",
  ]},
], "Overview");

// ═══════════════════════════════════════════════════════════════
// SECTION A: CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════
sectionDivider("SECTION A\nClinical Features");

// A1 – Malabsorption Syndrome
contentSlide("Clinical Features: Malabsorption Syndrome", [
  { head: "GI Symptoms", subs: [
    "Chronic diarrhea / steatorrhea (bulky, foul-smelling, pale, floating stools)",
    "Bloating, flatulence, abdominal cramps",
    "Nausea, anorexia, weight loss",
  ]},
  { head: "Nutritional Deficiencies", subs: [
    "Fat-soluble vitamins (A, D, E, K): night blindness, osteomalacia, coagulopathy",
    "Vitamin B12 / Folate: megaloblastic anemia, glossitis",
    "Iron deficiency: microcytic anemia, koilonychia",
    "Calcium/Magnesium: tetany, muscle cramps",
    "Protein: peripheral edema, hypoalbuminemia, muscle wasting",
  ]},
  { head: "Systemic Signs", subs: [
    "Clubbing, pallor, cheilosis, angular stomatitis",
    "Dermatitis herpetiformis (in celiac overlap)",
    "Growth retardation in children",
  ]},
], "Clinical Features");

// A2 – Celiac Disease
contentSlide("Clinical Features: Celiac Disease", [
  { head: "Classic Presentation", subs: [
    "Chronic diarrhea, steatorrhea, weight loss",
    "Abdominal bloating and distension",
    "Failure to thrive / short stature in children",
  ]},
  { head: "Atypical / Silent Forms", subs: [
    "Iron-deficiency anemia unresponsive to oral iron",
    "Osteoporosis / osteopenia (often presenting complaint in adults)",
    "Elevated transaminases (celiac hepatitis)",
    "Infertility, recurrent miscarriage",
    "Neurological: ataxia, peripheral neuropathy",
  ]},
  { head: "Dermatological", subs: [
    "Dermatitis herpetiformis – intensely pruritic vesicular rash on elbows, knees, buttocks",
  ]},
  { head: "Associated Conditions", subs: [
    "Type 1 diabetes mellitus, autoimmune thyroid disease",
    "Down syndrome, Turner syndrome (increased prevalence)",
  ]},
], "Clinical Features");

// A3 – Tropical Sprue
contentSlide("Clinical Features: Tropical Sprue", [
  { head: "Epidemiology / Setting", subs: [
    "Affects residents of / travelers to tropical regions (South Asia, Caribbean, Africa)",
    "Insidious onset; may occur in expatriates",
  ]},
  { head: "GI Features", subs: [
    "Profuse watery diarrhea progressing to steatorrhea",
    "Anorexia, nausea, abdominal discomfort",
    "Significant weight loss and nutritional depletion",
  ]},
  { head: "Systemic / Nutritional", subs: [
    "Megaloblastic anemia (B12 and folate deficiency)",
    "Glossitis, stomatitis, chelosis",
    "Peripheral edema due to protein malabsorption",
    "Hypocalcemia: tetany, muscle weakness",
  ]},
  { head: "Course", subs: [
    "Self-limiting in short-term travelers; chronic in residents without treatment",
  ]},
], "Clinical Features");

// A4 – Crohn's Disease (Small Bowel)
contentSlide("Clinical Features: Crohn's Disease (Small Intestine)", [
  { head: "Intestinal Features", subs: [
    "Chronic, recurrent right iliac fossa pain (terminal ileum most commonly affected)",
    "Diarrhea (non-bloody in small bowel disease)",
    "Nausea, vomiting, weight loss",
    "Palpable tender mass in RIF",
    "Intestinal obstruction (strictures), fistulae, abscesses",
  ]},
  { head: "Perianal Disease", subs: [
    "Fissures, fistulae, skin tags, abscesses",
  ]},
  { head: "Extraintestinal Manifestations", subs: [
    "Joints: peripheral arthritis, sacroiliitis, ankylosing spondylitis",
    "Eyes: uveitis, episcleritis",
    "Skin: erythema nodosum, pyoderma gangrenosum",
    "Liver: primary sclerosing cholangitis, fatty liver",
    "Renal: oxalate stones (enteric hyperoxaluria)",
  ]},
  { head: "Systemic", subs: [
    "Fever, malaise, fatigue; growth retardation in children",
  ]},
], "Clinical Features");

// A5 – Small Intestinal Obstruction
contentSlide("Clinical Features: Small Intestinal Obstruction", [
  { head: "Cardinal Symptoms (4 Hallmarks)", subs: [
    "1. Colicky abdominal pain – central / periumbilical; periodic, crescendo-decrescendo",
    "2. Vomiting – early and profuse (bilious) in high obstruction; feculent in low/late obstruction",
    "3. Abdominal distension – more marked in distal obstruction",
    "4. Absolute constipation / obstipation – late sign; may still pass flatus initially",
  ]},
  { head: "Physical Signs", subs: [
    "Visible peristalsis in thin patients",
    "High-pitched 'tinkling' or 'rushing' bowel sounds (early); absent sounds (late/strangulation)",
    "Tympanic percussion",
    "Dehydration signs: dry mucosa, tachycardia, decreased urine output",
  ]},
  { head: "Signs of Strangulation (Emergency)", subs: [
    "Continuous (non-colicky) severe pain, pyrexia, peritonism, hemodynamic instability",
    "Elevated WBC, lactic acidosis",
  ]},
], "Clinical Features");

// A6 – Short Bowel / Short Gut Syndrome
contentSlide("Clinical Features: Short Bowel (Short Gut) Syndrome", [
  { head: "Definition", subs: [
    "Insufficient intestinal length/function to absorb adequate nutrients and fluids",
    "Typically < 200 cm remaining small bowel (or < 100 cm without ileocecal valve)",
  ]},
  { head: "GI Features", subs: [
    "Severe, high-volume diarrhea / steatorrhea",
    "Oral hyperphagia yet progressive weight loss",
    "Abdominal cramping, bloating",
    "Dehydration, electrolyte disturbances (Na, K, Mg, Ca, Zn)",
  ]},
  { head: "Nutritional Deficiencies", subs: [
    "Protein-calorie malnutrition, muscle wasting, edema",
    "B12 deficiency (if ileum resected): anemia, neuropathy",
    "Fat-soluble vitamin deficiencies (A, D, E, K)",
    "Iron, zinc, selenium deficiencies",
  ]},
  { head: "Phases", subs: [
    "Phase 1 (0-3 mo): Maximal diarrhea, fluid/electrolyte losses, TPN dependence",
    "Phase 2 (3-12 mo): Intestinal adaptation, gradual tolerance of enteral feeds",
    "Phase 3 (>12 mo): Stabilization; some achieve enteral autonomy",
  ]},
], "Clinical Features");

// A7 – SIBO
contentSlide("Clinical Features: Small Intestinal Bacterial Overgrowth (SIBO)", [
  { head: "GI Symptoms", subs: [
    "Bloating, abdominal distension, flatulence",
    "Diarrhea (often watery or steatorrheic)",
    "Nausea, abdominal discomfort/pain",
  ]},
  { head: "Nutritional Consequences", subs: [
    "Vitamin B12 deficiency: megaloblastic anemia, neurological symptoms",
    "Fat-soluble vitamin (A, D, E, K) deficiencies",
    "Protein malnutrition with hypoalbuminemia",
  ]},
  { head: "Predisposing Conditions", subs: [
    "Anatomical: blind loops, strictures, diverticula, surgically altered anatomy",
    "Motility disorders: scleroderma, diabetic autonomic neuropathy",
    "Hypochlorhydria, immunodeficiency",
    "Cirrhosis, chronic pancreatitis, celiac disease (non-responsive)",
  ]},
], "Clinical Features");

// ═══════════════════════════════════════════════════════════════
// SECTION B: INVESTIGATIONS
// ═══════════════════════════════════════════════════════════════
sectionDivider("SECTION B\nInvestigations");

// B1 – Malabsorption
contentSlide("Investigations: Malabsorption Syndrome", [
  { head: "Blood Tests", subs: [
    "CBC: anemia (microcytic / macrocytic / mixed)",
    "Serum albumin, total protein (low in severe malabsorption)",
    "Serum iron, ferritin, TIBC; B12, folate levels",
    "Calcium, phosphate, alkaline phosphatase (metabolic bone disease)",
    "PT/INR (vitamin K deficiency)",
    "Anti-tTG IgA + total IgA (screen for celiac)",
  ]},
  { head: "Stool Tests", subs: [
    "Sudan III stain / fecal fat (72-hr collection): quantifies fat malabsorption (>7 g/day = steatorrhea)",
    "Fecal elastase-1: pancreatic exocrine insufficiency",
    "Stool culture, O&P for infections",
  ]},
  { head: "Imaging & Endoscopy", subs: [
    "Small bowel follow-through (SBFT) / CT enterography: mucosal pattern, strictures, fistulae",
    "Upper GI endoscopy with duodenal biopsies (x4)",
    "Capsule endoscopy: mucosal lesions beyond reach",
  ]},
  { head: "Functional Tests", subs: [
    "D-xylose absorption test: mucosal vs. pancreatic malabsorption",
    "Schilling test: B12 absorption",
    "Hydrogen breath test: lactose intolerance, SIBO",
  ]},
], "Investigations");

// B2 – Celiac Disease
contentSlide("Investigations: Celiac Disease", [
  { head: "Serology (First Line)", subs: [
    "Anti-tissue transglutaminase IgA (anti-tTG IgA) – sensitivity 95%, specificity 95%",
    "Total serum IgA (to exclude IgA deficiency; if deficient use IgG-based tests)",
    "Anti-endomysial antibody (EMA-IgA): high specificity, operator-dependent",
    "Deamidated gliadin peptide (DGP IgG): use in IgA deficiency or children <2 yrs",
  ]},
  { head: "Duodenal Biopsy (Gold Standard)", subs: [
    "Marsh Classification: 0 (normal) → 1 (increased IEL) → 2 (crypt hyperplasia) → 3a/b/c (villous atrophy)",
    "Multiple biopsies from D2 (x4) and duodenal bulb (x1) required",
  ]},
  { head: "HLA Typing", subs: [
    "HLA-DQ2 / DQ8: present in >99% of celiac patients; high negative predictive value",
    "Useful when diagnosis uncertain (e.g., patient already on GFD)",
  ]},
  { head: "Additional", subs: [
    "DEXA scan: bone mineral density (osteoporosis common)",
    "Thyroid function, LFTs, glucose",
  ]},
], "Investigations");

// B3 – Tropical Sprue
contentSlide("Investigations: Tropical Sprue", [
  { head: "Blood Tests", subs: [
    "CBC: megaloblastic anemia (macrocytic)",
    "Serum B12 and folate levels (both typically low)",
    "Serum albumin, calcium, phosphate, electrolytes",
    "Anti-tTG IgA (to exclude celiac disease)",
  ]},
  { head: "Stool Examination", subs: [
    "Fecal fat: increased (steatorrhea)",
    "Stool culture, O&P: to exclude infectious diarrhea",
  ]},
  { head: "Small Bowel Biopsy", subs: [
    "Partial villous atrophy with crypt hyperplasia and increased IELs",
    "Less severe than celiac; subtotal atrophy unusual",
    "Key: no response to gluten withdrawal (distinguishes from celiac)",
  ]},
  { head: "Imaging", subs: [
    "Barium follow-through: dilatation, coarsening of mucosal folds",
    "CT abdomen: rule out lymphoma, TB, other structural causes",
  ]},
  { head: "D-Xylose Absorption Test", subs: [
    "Abnormal (< 20 g excreted in 5 hrs): confirms mucosal malabsorption",
  ]},
], "Investigations");

// B4 – Crohn's Disease
contentSlide("Investigations: Crohn's Disease (Small Intestine)", [
  { head: "Blood Tests", subs: [
    "CBC: anemia (normocytic or mixed), leukocytosis (active/abscess)",
    "CRP, ESR, plasma viscosity: disease activity",
    "Serum albumin, B12, folate, iron studies",
    "LFTs, renal function",
  ]},
  { head: "Stool Tests", subs: [
    "Fecal calprotectin: elevated in active intestinal inflammation (>50 µg/g = active; >250 = likely IBD)",
    "Stool cultures: to exclude infection",
    "Fecal lactoferrin",
  ]},
  { head: "Endoscopy & Biopsy", subs: [
    "Ileocolonoscopy with biopsies: 'skip lesions', cobblestoning, deep ulcers, strictures",
    "Histology: transmural inflammation, non-caseating granulomas (pathognomonic)",
  ]},
  { head: "Imaging", subs: [
    "CT/MR enterography (gold standard for small bowel): mural thickening, fibrosis, fistulae, abscesses",
    "Small bowel capsule endoscopy: mucosal disease beyond colonoscope",
    "USS abdomen: first-line for complications",
  ]},
  { head: "Serology", subs: [
    "ASCA (anti-Saccharomyces cerevisiae antibody): positive in ~60% of Crohn's disease",
  ]},
], "Investigations");

// B5 – Small Intestinal Obstruction
contentSlide("Investigations: Small Intestinal Obstruction", [
  { head: "Plain X-Ray (Erect + Supine)", subs: [
    "Multiple dilated small bowel loops (>3 cm central, >2.5 cm peripheral)",
    "Air-fluid levels in step-ladder pattern on erect film",
    "Paucity of colonic gas",
    "Free gas under diaphragm → perforation",
  ]},
  { head: "CT Abdomen & Pelvis (Investigation of Choice)", subs: [
    "Identifies transition point, cause (adhesion, hernia, tumor, volvulus)",
    "Detects closed-loop obstruction, strangulation (bowel wall edema, mesenteric haziness, portal gas)",
    "Differentiates partial vs. complete obstruction",
  ]},
  { head: "Blood Tests", subs: [
    "FBC, U&E: dehydration, electrolyte imbalances",
    "LFTs, amylase",
    "ABG / lactate: elevated lactate suggests strangulation/ischemia",
    "Blood cultures if septic",
  ]},
  { head: "Others", subs: [
    "Water-soluble contrast study (Gastrografin): confirms/resolves partial obstruction (adhesive)",
    "USS: free fluid, dilated loops; limited by bowel gas",
  ]},
], "Investigations");

// B6 – Short Gut Syndrome
contentSlide("Investigations: Short Bowel Syndrome", [
  { head: "Nutritional Assessment", subs: [
    "Serum albumin, pre-albumin, transferrin",
    "Full vitamin panel: B12, folate, vitamins A, D (25-OH), E, K (PT/INR)",
    "Trace elements: zinc, selenium, copper",
    "Serum electrolytes: Na, K, Mg, Ca, phosphate",
    "CBC: anemia screen",
  ]},
  { head: "GI Function Tests", subs: [
    "72-hour fecal fat quantification",
    "Fecal sodium, potassium",
    "D-xylose absorption",
    "Hydrogen breath test (SIBO, which is common complication)",
  ]},
  { head: "Imaging", subs: [
    "Contrast small bowel study / CT enterography: bowel length assessment, dilatation (adaptation)",
    "Liver USS/LFTs: TPN-associated liver disease",
    "DEXA: metabolic bone disease",
  ]},
  { head: "Other", subs: [
    "Intraoperative bowel measurement (during resection)",
    "Endoscopy: assess mucosal adaptation, rule out ongoing disease",
  ]},
], "Investigations");

// B7 – SIBO
contentSlide("Investigations: SIBO", [
  { head: "Breath Tests (Non-Invasive, First Line)", subs: [
    "Hydrogen/methane breath test with glucose or lactulose",
    "Glucose H2 breath test: >20 ppm rise within 90 min = positive (better specificity)",
    "Lactulose H2 breath test: earlier peak <90 min (less specific due to colonic fermentation)",
  ]},
  { head: "Jejunal Aspirate & Culture (Gold Standard)", subs: [
    ">10³ CFU/mL (some say >10⁵) from duodenal/jejunal aspirate",
    "Invasive, expensive, risk of contamination, not routinely performed",
  ]},
  { head: "Blood Tests", subs: [
    "Vitamin B12 (low), folate (elevated – synthesized by bacteria), serum albumin",
    "CBC: macrocytic anemia",
  ]},
  { head: "Other", subs: [
    "CT/MR enterography: anatomical predisposing factors (diverticula, strictures, fistulae)",
    "Manometry: dysmotility as underlying cause",
  ]},
], "Investigations");

// ═══════════════════════════════════════════════════════════════
// SECTION C: PRINCIPLES OF MANAGEMENT
// ═══════════════════════════════════════════════════════════════
sectionDivider("SECTION C\nPrinciples of Management");

// C1 – Malabsorption
contentSlide("Management: Malabsorption Syndrome", [
  { head: "Treat Underlying Cause", subs: [
    "Celiac disease → gluten-free diet",
    "Tropical sprue → folic acid + tetracycline",
    "Pancreatic insufficiency → enzyme replacement",
    "SIBO → antibiotics (rifaximin)",
    "Crohn's disease → immunosuppression / biologics",
  ]},
  { head: "Nutritional Support", subs: [
    "High-calorie, high-protein diet; medium-chain triglycerides (MCT) in fat malabsorption",
    "Elemental / polymeric enteral feeds if oral intake inadequate",
    "Parenteral nutrition (TPN) in severe cases",
  ]},
  { head: "Vitamin & Mineral Supplementation", subs: [
    "Oral/parenteral iron; B12 injections; folic acid",
    "Calcium + vitamin D supplementation; bisphosphonates for osteoporosis",
    "Fat-soluble vitamins (A, D, E, K) – parenteral if severe malabsorption",
    "Zinc, magnesium supplementation",
  ]},
  { head: "Symptomatic", subs: [
    "Antidiarrheal agents (loperamide, codeine) as adjuncts",
    "Cholestyramine: bile acid malabsorption diarrhea",
  ]},
], "Management");

// C2 – Celiac Disease
contentSlide("Management: Celiac Disease", [
  { head: "Strict Lifelong Gluten-Free Diet (GFD) – Cornerstone", subs: [
    "Eliminate wheat, rye, barley (oats may be tolerated in most)",
    "Dietician referral essential; label reading, cross-contamination awareness",
    "Mucosal healing expected within 6-24 months on strict GFD",
  ]},
  { head: "Monitoring Response", subs: [
    "Repeat anti-tTG IgA at 6 and 12 months (should normalize on GFD)",
    "Repeat duodenal biopsy if serology fails to normalize or symptoms persist",
    "DEXA scan at diagnosis; repeat in 1-2 years",
  ]},
  { head: "Supplementation", subs: [
    "Iron (PO or IV), folate, B12 injections if deficient",
    "Calcium + vitamin D; zinc",
    "Vitamins A, K if fat malabsorption severe",
  ]},
  { head: "Refractory Celiac Disease", subs: [
    "Type I (responsive polyclonal IELs): budesonide, azathioprine",
    "Type II (clonal IELs – risk of enteropathy-associated T-cell lymphoma): cladribine, stem cell transplant",
  ]},
  { head: "Surveillance", subs: [
    "Annual review; DEXA every 2-5 years",
    "Capsule endoscopy if refractory / suspected complications",
  ]},
], "Management");

// C3 – Tropical Sprue
contentSlide("Management: Tropical Sprue", [
  { head: "First-Line Treatment", subs: [
    "Tetracycline 250 mg QDS OR doxycycline 100 mg OD × 3-6 months",
    "Folic acid 5 mg/day (essential – most patients are folate-deficient)",
    "Combination therapy results in resolution in most cases",
  ]},
  { head: "Adjuncts", subs: [
    "Vitamin B12 injections (intramuscular) if deficient",
    "Nutritional support: high-calorie, high-protein diet",
    "Oral rehydration / IV fluids if dehydrated",
    "Iron supplementation as needed",
  ]},
  { head: "Duration of Treatment", subs: [
    "Short-term travelers: 3 months usually sufficient",
    "Long-term residents or severe disease: up to 6 months",
  ]},
  { head: "Relapse Prevention", subs: [
    "Address underlying hygiene / contaminated water/food sources",
    "Prophylactic folic acid for travelers to endemic areas",
  ]},
], "Management");

// C4 – Crohn's Disease
contentSlide("Management: Crohn's Disease (Small Intestine)", [
  { head: "Induce Remission", subs: [
    "Mild-moderate: oral budesonide (ileal/right colonic Crohn's) OR prednisolone",
    "Exclusive enteral nutrition (EEN) – first choice in children to induce remission",
    "Moderate-severe: IV hydrocortisone / methylprednisolone",
  ]},
  { head: "Maintain Remission", subs: [
    "Azathioprine / 6-mercaptopurine (thiopurines): first-line steroid-sparing",
    "Methotrexate: alternative if thiopurine-intolerant",
    "Anti-TNF agents: infliximab, adalimumab (moderate-severe / fistulizing)",
    "Vedolizumab (anti-integrin), ustekinumab (anti-IL12/23): second-line biologics",
  ]},
  { head: "Surgery", subs: [
    "Indications: obstruction, abscess, fistula, perforation, failure of medical therapy",
    "Resection with primary anastomosis; stricturoplasty (to preserve bowel length)",
    "Laparoscopic approach preferred",
  ]},
  { head: "Nutritional Support & Monitoring", subs: [
    "Nutritional rehabilitation; B12 replacement post-ileal resection",
    "Regular monitoring: CRP, calprotectin, endoscopy (treat-to-target)",
  ]},
], "Management");

// C5 – Small Intestinal Obstruction
contentSlide("Management: Small Intestinal Obstruction", [
  { head: "Initial Resuscitation (All Cases)", subs: [
    "IV access; aggressive IV fluid resuscitation (crystalloids)",
    "NG tube: nasogastric decompression ('drip and suck')",
    "Urinary catheter: monitor urine output",
    "Correct electrolyte imbalances (Na, K, Cl, bicarbonate)",
    "Analgesia (IV opioids); antiemetics",
    "NBM; broad-spectrum antibiotics if signs of strangulation/infection",
  ]},
  { head: "Conservative Management", subs: [
    "Appropriate in partial obstruction (e.g., adhesive): 24-72 hours",
    "Gastrografin (water-soluble contrast): both diagnostic and therapeutic for adhesive obstruction",
  ]},
  { head: "Surgical Management", subs: [
    "EMERGENCY surgery: complete obstruction, strangulation, peritonitis, failure of conservative Rx",
    "Adhesiolysis (adhesion division) – most common operation",
    "Bowel resection with anastomosis if ischemic/necrotic bowel",
    "Reduction of hernia; treatment of specific cause",
    "Laparoscopic approach where possible",
  ]},
  { head: "Post-op", subs: [
    "Early enteral feeding; DVT prophylaxis; ERAS protocol",
  ]},
], "Management");

// C6 – Short Gut Syndrome (DETAILED - major focus)
contentSlide("Management: Short Bowel Syndrome – Nutritional Support", [
  { head: "Phase 1: Acute Phase (0-3 months)", subs: [
    "Total parenteral nutrition (TPN): primary source of nutrition; maintain positive nitrogen balance",
    "IV fluid replacement: match stomal/diarrheal losses",
    "Electrolyte correction: Na, K, Mg, Ca, Zn, PO4",
    "Proton pump inhibitors / H2 blockers: reduce hypergastrinemia and fluid losses",
    "Antidiarrheal agents: loperamide, codeine to slow transit",
    "Octreotide: reduces intestinal secretions in severe cases (use judiciously)",
  ]},
  { head: "Phase 2: Adaptation Phase (3-12 months)", subs: [
    "Introduce oral/enteral feeds gradually: polymeric → elemental if needed",
    "Oral rehydration solutions (ORS): high Na content (90 mmol/L) to replace losses",
    "Small, frequent meals; low-fat diet if colon in continuity",
    "Increase enteral intake while weaning TPN",
  ]},
  { head: "Phase 3: Stabilization / Maintenance", subs: [
    "Achieve enteral autonomy if possible (depends on residual bowel length & function)",
    "Home TPN for those unable to achieve enteral autonomy",
  ]},
], "Management");

contentSlide("Management: Short Bowel Syndrome – Pharmacological & Surgical", [
  { head: "GLP-2 Agonists (Teduglutide)", subs: [
    "Analog of GLP-2: promotes intestinal mucosal growth, reduces secretions",
    "Reduces TPN requirements; FDA/EMA approved for SBS-intestinal failure",
    "Dose: 0.05 mg/kg/day SC; requires colonoscopy screening (risk of GI polyps)",
  ]},
  { head: "Other Pharmacological Agents", subs: [
    "Growth hormone (somatropin): improves gut absorption (used with glutamine)",
    "Glutamine supplementation: mucosal trophic effect",
    "Bile acid sequestrants (cholestyramine): for bile acid diarrhea (colon in continuity)",
    "Antibiotics (rifaximin): for concurrent SIBO",
  ]},
  { head: "Surgical Options (Bowel-Lengthening Procedures)", subs: [
    "Bianchi procedure (LILT): longitudinal intestinal lengthening & tailoring; doubles bowel length",
    "STEP (Serial Transverse Enteroplasty): serial stapling of dilated bowel; minimally invasive",
    "Both indicated for dilated, dysfunctional bowel in TPN-dependent patients",
    "Intestinal transplantation: last resort for irreversible intestinal failure with TPN complications",
  ]},
  { head: "Monitoring", subs: [
    "Regular TPN-related monitoring: LFTs (TPN-cholestasis), line sepsis, bone density",
    "Annual review of nutritional markers, trace elements",
  ]},
], "Management");

// C7 – SIBO
contentSlide("Management: Small Intestinal Bacterial Overgrowth (SIBO)", [
  { head: "Treat Underlying Cause", subs: [
    "Correct anatomical abnormalities surgically where possible (blind loops, strictures)",
    "Manage motility disorders; optimize glycemic control in diabetes",
    "Discontinue proton pump inhibitors if contributing",
  ]},
  { head: "Antibiotic Treatment (First Line)", subs: [
    "Rifaximin 550 mg TDS × 14 days (non-absorbable; preferred – minimal systemic effects)",
    "Alternatives: metronidazole + trimethoprim-sulfamethoxazole, ciprofloxacin, norfloxacin",
    "Rotate antibiotics to reduce resistance; 2-week on / 2-week off cycling",
  ]},
  { head: "Nutritional Support", subs: [
    "Correct B12 deficiency (IM injections), fat-soluble vitamins",
    "Low-FODMAP diet may reduce symptoms",
    "Lactose-free diet if secondary lactase deficiency",
  ]},
  { head: "Prokinetics", subs: [
    "Prucalopride, metoclopramide: improve motility in dysmotility-driven SIBO",
  ]},
  { head: "Probiotics", subs: [
    "Limited evidence; Lactobacillus species may offer modest benefit",
  ]},
], "Management");

// ── SUMMARY SLIDE ──────────────────────────────────────────────
contentSlide("Summary: Key Points", [
  { head: "Malabsorption & Celiac", subs: [
    "Anti-tTG IgA + duodenal biopsy (Marsh grading) are diagnostic cornerstones for celiac",
    "Strict lifelong GFD is the only treatment for celiac disease",
  ]},
  { head: "Tropical Sprue & SIBO", subs: [
    "Tetracycline + folic acid for tropical sprue; rifaximin is first-line for SIBO",
  ]},
  { head: "Crohn's Disease", subs: [
    "Transmural inflammation with skip lesions; treat-to-target with biologics",
    "Surgery for complications; stricturoplasty to preserve bowel length",
  ]},
  { head: "Obstruction", subs: [
    "Drip & suck for initial management; CT identifies strangulation – surgical emergency",
  ]},
  { head: "Short Bowel Syndrome", subs: [
    "TPN in acute phase → enteral adaptation → teduglutide (GLP-2) → surgical lengthening → transplant",
    "Goal: achieve enteral autonomy; minimize TPN-related complications",
  ]},
], "Summary");

// ── FINAL TITLE ────────────────────────────────────────────────
titleSlide("Thank You", "Clinical Excellence in Small Intestine Disorders");

// ── WRITE FILE ─────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/small-intestine-ppt/Small_Intestine_Disorders.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/small-intestine-ppt/Small_Intestine_Disorders.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/small-intestine-ppt && node create_pptx.js

ls -lh /home/daytona/workspace/small-intestine-ppt/Small_Intestine_Disorders.ppt…