const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─────────────────────────────────────────────────────────────────
// FETCH IMAGES
// ─────────────────────────────────────────────────────────────────
const imageUrls = [
  // 0 – RIF mass overview / overview CT
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e03e72d4af7428fe57e6cd7144a4847a6cd130b319465d6468289e44f2b4a718.jpg",
  // 1 – Appendicular phlegmon US
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_df3fb89bf24ccce9b27c9eae8f28608c24bc91c0f6ca7db1465dfab83e7bbf1d.jpg",
  // 2 – Appendiceal abscess CT axial
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_a4e18e95ce302d9a5b2d2235a7b2acb1deac79b41526a7c2906912e56f472e87.jpg",
  // 3 – Appendiceal mucocele CT
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7f6658f67a70ba5cada6da9123255609d69c021defb33f2b14774769165d19be.jpg",
  // 4 – Ileocecal TB coronal CT (before/after ATT)
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_cf9ce00c108f113a6cb8e949d5322c823ad238e1bad76d4585e85f2f3d858517.jpg",
  // 5 – Ileocecal TB axial CT wall thickening
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_d8756dce4b4f26693dde5457a7d6d06d85f4f135302aa63b5b8a318bc1144a1b.jpg",
  // 6 – Crohn's disease RIF abscess CT
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_946425e61c12a44f8c44dfc5f0b94e6209d8b80ce762bbc25a8a48a00b8f0559.jpg",
  // 7 – Crohn's terminal ileum CT comb sign
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_10478fac4cfc39c9a44595169568317aa389b3c3797078dac73c7d9fd7e22643.jpg",
  // 8 – Cecal carcinoma CT mass
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_248486df466254dc29c2fbe06f29aeb43810883e2aa0c7d07921c4a3bbc132be.jpg",
  // 9 – Right hemicolectomy specimen
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_78cc1e15cdc62e923639ce52911af128261d17195c39da6eaefcd659fb6fe0c9.jpg",
  // 10 – Ovarian torsion CT whirlpool sign
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e7448b30c79e830748e9a8f54b38a94092774f0ecca63bb1c4888b453dd34466.jpg",
  // 11 – Psoas abscess right side CT
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_64289d252966f351d61982c88710dac73fed898cda45b3287372392a352c7027.jpg",
  // 12 – Psoas abscess bilateral CT
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_66135e71eb9523206b0d79ea1a9de1cbaade681da129e3e194698be7d41dc30c.jpg",
  // 13 – Rectus sheath hematoma CT axial
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6fdaa566f820444c5b98061354aa99424bcec83d19c601703e3e8e51cd21de83.jpg",
  // 14 – Rectus sheath hematoma coronal CT
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_a4f1013579427230a37ef2ca0167d2ec656fcf23b8770a9e7d00027725ea6e7b.jpg",
  // 15 – Desmoid tumor MRI FAP
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_c4a3a7b6d36e7dec5d5c81e8fcd25f5929c94db7754e1b70b07eeb4742c91bfb.jpg",
  // 16 – Ileocecal TB pediatric CT calcified nodes
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0a31147251d631d88c1fe10d6c2539f7e67b0f34391f5fc5351a195c887ee31b.jpg",
  // 17 – Ovarian torsion US whirl sign + CT + specimen
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_daaf0770ce1722690df939859c5e1a04ab4ddc53c0563fa7ba2ac581d6957b39.jpg",
  // 18 – RIF phlegmon ROCO US
  "https://cdn.orris.care/cdss_images/roco_radiology_ROCO_34063_1766648007727.png",
  // 19 – Ileocecal complex mass + pericaecal abscess CT
  "https://cdn.orris.care/cdss_images/roco_radiology_ROCO_33895_1766647994697.png",
];

console.log("Fetching images...");
const imagesRaw = execSync(
  `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
  { maxBuffer: 200 * 1024 * 1024 }
).toString();
const images = JSON.parse(imagesRaw);
console.log("Images fetched:", images.filter(i => !i.error).length, "OK,", images.filter(i => i.error).length, "failed");

function img(idx) {
  const i = images[idx];
  return (!i || i.error) ? null : i.base64;
}

// ─────────────────────────────────────────────────────────────────
// PRESENTATION SETUP
// ─────────────────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3 x 7.5
pres.title = "Differential Diagnosis of RIF Mass";
pres.author = "General Surgery Resident Seminar";

// ─────────────────────────────────────────────────────────────────
// THEME COLORS
// ─────────────────────────────────────────────────────────────────
const C = {
  navy:    "0D2137",
  teal:    "1A6B7C",
  gold:    "D4A030",
  white:   "FFFFFF",
  light:   "EEF4F7",
  gray:    "8A9BAD",
  dark:    "1C2D3C",
  green:   "1E7A55",
  red:     "B03030",
  orange:  "CC5500",
  purple:  "5C2E7E",
  lblue:   "3A8FC7",
};

// ─────────────────────────────────────────────────────────────────
// HELPER FUNCTIONS
// ─────────────────────────────────────────────────────────────────
function addSlideHeader(slide, title, accent = C.teal) {
  // top header bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.75, fill: { color: C.navy } });
  slide.addText(title, {
    x: 0.3, y: 0, w: 12.7, h: 0.75,
    fontSize: 22, bold: true, color: C.white, valign: "middle", fontFace: "Calibri",
  });
  // accent stripe
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: "100%", h: 0.08, fill: { color: accent } });
}

function addSectionDivider(slide, sectionLabel, color = C.teal) {
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.9, w: 0.12, h: 0.35, fill: { color } });
  slide.addText(sectionLabel, {
    x: 0.52, y: 0.9, w: 12, h: 0.35,
    fontSize: 13, bold: true, color, valign: "middle", fontFace: "Calibri",
  });
}

function addBullets(slide, items, x, y, w, h, opts = {}) {
  const textArr = items.map((it, i) => ({
    text: it,
    options: {
      bullet: { type: "bullet", indent: opts.indent || 15 },
      breakLine: i < items.length - 1,
      fontSize: opts.fontSize || 13,
      color: opts.color || C.dark,
      bold: opts.bold || false,
      fontFace: "Calibri",
    }
  }));
  slide.addText(textArr, { x, y, w, h, valign: "top", fontFace: "Calibri" });
}

function addTwoCol(slide, leftItems, rightItems, yStart = 1.05) {
  const colW = 6.2, colH = 5.8, gap = 0.2;
  const lx = 0.3, rx = lx + colW + gap;
  addBullets(slide, leftItems, lx, yStart, colW, colH);
  addBullets(slide, rightItems, rx, yStart, colW, colH);
}

function addImageWithCaption(slide, imgData, x, y, w, h, caption) {
  if (imgData) {
    slide.addImage({ data: imgData, x, y, w, h });
  } else {
    slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: "CCCCCC" } });
    slide.addText("Image unavailable", { x, y, w, h, fontSize: 10, color: "666666", align: "center", valign: "middle" });
  }
  if (caption) {
    slide.addText(caption, {
      x, y: y + h + 0.05, w, h: 0.35,
      fontSize: 9, color: C.gray, italic: true, align: "center", fontFace: "Calibri",
    });
  }
}

function categoryBadge(slide, label, color) {
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 0.83, w: 2.5, h: 0.28,
    fill: { color }, line: { color, width: 0 },
    rectRadius: 0.05,
  });
  slide.addText(label, {
    x: 0.3, y: 0.83, w: 2.5, h: 0.28,
    fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri",
  });
}

function bgFill(slide, color = C.white) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color }, line: { color, width: 0 } });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.navy);

  // decorative shapes
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.8, w: "100%", h: 1.7, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.5, h: "100%", fill: { color: C.gold }, line: { color: C.gold, width: 0 } });

  if (img(0)) s.addImage({ data: img(0), x: 8.5, y: 0.8, w: 4.5, h: 4.8 });
  // subtle overlay on image
  s.addShape(pres.ShapeType.rect, { x: 8.5, y: 0.8, w: 4.5, h: 4.8, fill: { color: C.navy, transparency: 40 }, line: { color: C.navy, width: 0 } });

  s.addText("DIFFERENTIAL DIAGNOSIS OF", {
    x: 0.8, y: 1.2, w: 7.8, h: 0.6,
    fontSize: 18, color: C.gold, bold: false, fontFace: "Calibri", charSpacing: 3,
  });
  s.addText("RIF MASS", {
    x: 0.8, y: 1.8, w: 7.8, h: 1.4,
    fontSize: 58, color: C.white, bold: true, fontFace: "Calibri",
  });
  s.addText("Right Iliac Fossa Mass", {
    x: 0.8, y: 3.2, w: 7.8, h: 0.6,
    fontSize: 20, color: C.light, italic: true, fontFace: "Calibri",
  });

  s.addText([
    { text: "General Surgery Resident Seminar  |  ", options: { color: C.white, fontSize: 13 } },
    { text: "Abdominal Wall  •  Intraperitoneal  •  Retroperitoneal", options: { color: C.gold, fontSize: 13, bold: true } },
  ], { x: 0.8, y: 4.1, w: 7.8, h: 0.5, fontFace: "Calibri" });

  s.addShape(pres.ShapeType.rect, { x: 0.8, y: 4.75, w: 5, h: 0.04, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });

  s.addText("Comprehensive approach to diagnosis, pathology, imaging & management", {
    x: 0.8, y: 5.85, w: 11.7, h: 0.5,
    fontSize: 13, color: C.white, fontFace: "Calibri", align: "center",
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 2 — ANATOMY & OVERVIEW
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "The Right Iliac Fossa — Anatomy & Clinical Significance", C.teal);

  // Left box: anatomical boundaries
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 4.0, h: 3.0, fill: { color: C.light }, line: { color: C.teal, width: 1 } });
  s.addText("ANATOMICAL BOUNDARIES", { x: 0.3, y: 0.95, w: 4.0, h: 0.4, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", fill: { color: C.teal } });
  addBullets(s, [
    "Superiorly: Plane through ASIS (iliac crest)",
    "Inferiorly: Inguinal ligament",
    "Medially: Right lateral border of rectus abdominis",
    "Laterally: Right flank / iliac fossa",
    "Floor: Iliacus + psoas muscles",
    "Anteriorly: Anterior abdominal wall",
  ], 0.4, 1.4, 3.8, 2.4, { fontSize: 11 });

  // Middle box: structures
  s.addShape(pres.ShapeType.rect, { x: 4.6, y: 0.95, w: 4.1, h: 3.0, fill: { color: C.light }, line: { color: C.navy, width: 1 } });
  s.addText("STRUCTURES IN THE RIF", { x: 4.6, y: 0.95, w: 4.1, h: 0.4, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", fill: { color: C.navy } });
  addBullets(s, [
    "Cecum & appendix",
    "Terminal ileum",
    "Right ovary & fallopian tube (♀)",
    "Right ureter",
    "Iliac vessels (ext/int)",
    "Iliopsoas muscle",
    "Inguinal lymph nodes",
    "Abdominal wall (skin→muscle→fascia)",
  ], 4.7, 1.4, 3.9, 2.4, { fontSize: 11 });

  // Right box: 3 categories
  s.addShape(pres.ShapeType.rect, { x: 9.0, y: 0.95, w: 4.0, h: 3.0, fill: { color: C.light }, line: { color: C.gold, width: 1 } });
  s.addText("3 ANATOMICAL LAYERS", { x: 9.0, y: 0.95, w: 4.0, h: 0.4, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", fill: { color: C.gold } });

  const cats = [
    { label: "1. ABDOMINAL WALL", color: C.orange, items: ["Rectus sheath hematoma", "Lipoma / Fibroma", "Desmoid tumor", "Spigelian hernia", "Seroma / Abscess"] },
    { label: "2. INTRAPERITONEAL", color: C.teal, items: ["Appendicular mass", "Ileocecal TB", "Crohn disease", "Cecal carcinoma", "Ovarian / Adnexal mass"] },
    { label: "3. RETROPERITONEAL", color: C.purple, items: ["Psoas abscess", "Iliac lymphadenopathy", "Retroperitoneal sarcoma", "Iliac artery aneurysm", "Undescended testis"] },
  ];
  cats.forEach((cat, ci) => {
    const cy = 1.42 + ci * 0.85;
    s.addShape(pres.ShapeType.roundRect, { x: 9.15, y: cy, w: 3.7, h: 0.28, fill: { color: cat.color }, line: { color: cat.color, width: 0 }, rectRadius: 0.04 });
    s.addText(cat.label, { x: 9.15, y: cy, w: 3.7, h: 0.28, fontSize: 9.5, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(cat.items.join("  •  "), { x: 9.15, y: cy + 0.3, w: 3.7, h: 0.48, fontSize: 8.5, color: C.dark, fontFace: "Calibri", valign: "top" });
  });

  // Bottom: approach table
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.1, w: 12.7, h: 0.35, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
  s.addText("CLINICAL APPROACH — History → Examination → Carnett's Test → Imaging (USG / CT) → Biopsy / Surgery", {
    x: 0.3, y: 4.1, w: 12.7, h: 0.35, fontSize: 11, color: C.white, bold: true, align: "center", valign: "middle", fontFace: "Calibri",
  });

  const approach = [
    ["History", "Duration, onset, fever, weight loss,\nmenstrual history, TB contact"],
    ["Examination", "Site, size, surface, consistency,\nCarnett's sign, Fothergill's sign"],
    ["Investigations", "CBC, ESR, CRP, CA-125, β-hCG,\nCEA, Mantoux / IGRA"],
    ["Imaging", "USG abdomen/pelvis (1st line)\nCT abdomen with contrast (gold std)"],
  ];
  approach.forEach(([hd, bd], i) => {
    const ax = 0.3 + i * 3.2;
    s.addShape(pres.ShapeType.rect, { x: ax, y: 4.5, w: 3.1, h: 0.4, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
    s.addText(hd, { x: ax, y: 4.5, w: 3.1, h: 0.4, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: ax, y: 4.9, w: 3.1, h: 0.85, fill: { color: C.light }, line: { color: C.teal, width: 0.5 } });
    s.addText(bd, { x: ax + 0.05, y: 4.9, w: 3.0, h: 0.85, fontSize: 10, color: C.dark, valign: "middle", fontFace: "Calibri" });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 3 — SECTION DIVIDER: ABDOMINAL WALL
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.dark);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.6, h: "100%", fill: { color: C.orange }, line: { color: C.orange, width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0.6, y: 2.5, w: 12.7, h: 0.08, fill: { color: C.orange }, line: { color: C.orange, width: 0 } });

  s.addText("SECTION 1", { x: 1.0, y: 1.5, w: 8, h: 0.6, fontSize: 20, color: C.orange, bold: false, charSpacing: 5, fontFace: "Calibri" });
  s.addText("ABDOMINAL WALL", { x: 1.0, y: 2.0, w: 10, h: 1.1, fontSize: 52, color: C.white, bold: true, fontFace: "Calibri" });
  s.addText("MASSES", { x: 1.0, y: 2.9, w: 10, h: 1.1, fontSize: 52, color: C.orange, bold: true, fontFace: "Calibri" });

  addBullets(s, [
    "Rectus Sheath Hematoma",
    "Lipoma / Fibroma / Sebaceous Cyst",
    "Desmoid Tumor (Aggressive Fibromatosis)",
    "Spigelian Hernia",
    "Abdominal Wall Abscess / Seroma",
    "Inguinal Hernia (indirect / Spigelian)",
    "Metastatic Umbilical Nodule (Sister Mary Joseph)",
  ], 1.0, 4.1, 8, 2.8, { fontSize: 13, color: C.light });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 4 — RECTUS SHEATH HEMATOMA
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Rectus Sheath Hematoma", C.orange);
  categoryBadge(s, "ABDOMINAL WALL", C.orange);

  // left panel
  addBullets(s, [
    "Hemorrhage within rectus sheath → epigastric vessels / direct muscle injury",
    "Causes: Anticoagulation, trauma, vigorous coughing, pregnancy",
    "Classic presentation: Acute RIF pain, tender fixed mass",
    "Fothergill's sign: Mass DOES NOT cross midline; remains palpable on rectus contraction",
    "Carnett's sign: Pain increases on tensing abdomen",
  ], 0.3, 1.3, 5.2, 2.5, { fontSize: 12 });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.9, w: 5.2, h: 0.35, fill: { color: C.orange }, line: { color: C.orange, width: 0 } });
  s.addText("MANAGEMENT", { x: 0.3, y: 3.9, w: 5.2, h: 0.35, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "Conservative: ICU monitoring, reverse anticoagulation, transfusion",
    "IR: Angioembolisation (angiography + embolisation of epigastric artery)",
    "Surgery: Evacuation of hematoma if expanding / infected",
    "Type I/II → conservative; Type III → often needs intervention",
  ], 0.3, 4.3, 5.2, 2.0, { fontSize: 11 });

  addImageWithCaption(s, img(13), 5.8, 0.9, 3.7, 3.0, "CT Axial — Hyperdense mass within right rectus muscle");
  addImageWithCaption(s, img(14), 9.7, 0.9, 3.3, 3.0, "CT Coronal — Rectus sheath hematoma with mass effect");

  // classification table
  s.addShape(pres.ShapeType.rect, { x: 5.8, y: 4.15, w: 7.2, h: 0.35, fill: { color: C.dark }, line: { color: C.dark, width: 0 } });
  s.addText("BERNÁ-MESTRE CLASSIFICATION", { x: 5.8, y: 4.15, w: 7.2, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  const typeRows = [
    ["Type I", "Intramuscular hematoma", "Conservative"],
    ["Type II", "Between muscle & transversalis fascia", "Conservative"],
    ["Type III", "Extends between peritoneum & fascia", "Intervention / Surgery"],
  ];
  typeRows.forEach(([t, desc, mgmt], ri) => {
    const ry = 4.55 + ri * 0.6;
    const bg = ri % 2 === 0 ? C.light : C.white;
    s.addShape(pres.ShapeType.rect, { x: 5.8, y: ry, w: 7.2, h: 0.55, fill: { color: bg }, line: { color: C.gray, width: 0.3 } });
    s.addText(t, { x: 5.85, y: ry + 0.05, w: 1.0, h: 0.45, fontSize: 10, bold: true, color: C.orange, fontFace: "Calibri" });
    s.addText(desc, { x: 6.85, y: ry + 0.05, w: 4.0, h: 0.45, fontSize: 10, color: C.dark, fontFace: "Calibri", valign: "middle" });
    s.addText(mgmt, { x: 10.85, y: ry + 0.05, w: 2.1, h: 0.45, fontSize: 10, color: C.teal, bold: true, fontFace: "Calibri", valign: "middle" });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 5 — LIPOMA / DESMOID / SPIGELIAN HERNIA
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Other Abdominal Wall Masses — Lipoma, Desmoid, Spigelian Hernia", C.orange);
  categoryBadge(s, "ABDOMINAL WALL", C.orange);

  const cards = [
    {
      title: "LIPOMA / FIBROMA",
      color: C.teal,
      pts: [
        "Commonest benign soft tissue tumors",
        "Soft, non-tender, mobile, lobulated",
        "Encapsulated mass within subcutaneous fat",
        "USG: Echogenic, compressible; MRI: Fat signal",
        "Rx: Excision if symptomatic; liposarcoma must be excluded",
      ],
    },
    {
      title: "DESMOID TUMOR (Aggressive Fibromatosis)",
      color: C.orange,
      pts: [
        "Low-grade fibroblastic tumors; locally invasive, NO metastasis",
        "Associated with FAP / Gardner syndrome (mesenteric desmoid)",
        "Post-surgical scar / trauma site",
        "MRI: T2 hypointense — hallmark of desmoid",
        "Rx: Surgery (R0), NSAIDs (sulindac), anti-oestrogens, imatinib",
      ],
      imgIdx: 15,
    },
    {
      title: "SPIGELIAN HERNIA",
      color: C.purple,
      pts: [
        "Hernia through Spigelian fascia (semi-lunar line)",
        "Lateral border of rectus, below arcuate line — RIF",
        "Often interparietal (between muscle layers) → easy to miss",
        "Risk: Incarceration / strangulation",
        "USG / CT: Fascial defect with bowel / fat herniation",
        "Rx: Surgical repair (open or laparoscopic)",
      ],
    },
  ];

  cards.forEach((card, ci) => {
    const cx = 0.3 + ci * 4.35;
    s.addShape(pres.ShapeType.rect, { x: cx, y: 0.95, w: 4.15, h: 0.4, fill: { color: card.color }, line: { color: card.color, width: 0 } });
    s.addText(card.title, { x: cx, y: 0.95, w: 4.15, h: 0.4, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: cx, y: 1.35, w: 4.15, h: 4.8, fill: { color: C.light }, line: { color: card.color, width: 0.8 } });
    addBullets(s, card.pts, cx + 0.1, 1.4, 3.95, card.imgIdx !== undefined ? 2.0 : 4.6, { fontSize: 11 });
    if (card.imgIdx !== undefined && img(card.imgIdx)) {
      addImageWithCaption(s, img(card.imgIdx), cx + 0.1, 3.5, 3.95, 2.5, "MRI: Desmoid tumors in FAP — mesenteric + abdominal wall");
    }
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 6 — SECTION DIVIDER: INTRAPERITONEAL
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.dark);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.6, h: "100%", fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0.6, y: 2.5, w: 12.7, h: 0.08, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });

  s.addText("SECTION 2", { x: 1.0, y: 1.5, w: 8, h: 0.6, fontSize: 20, color: C.teal, bold: false, charSpacing: 5, fontFace: "Calibri" });
  s.addText("INTRAPERITONEAL", { x: 1.0, y: 2.0, w: 11, h: 1.1, fontSize: 42, color: C.white, bold: true, fontFace: "Calibri" });
  s.addText("MASSES", { x: 1.0, y: 2.9, w: 10, h: 1.1, fontSize: 52, color: C.teal, bold: true, fontFace: "Calibri" });

  addBullets(s, [
    "Appendicular Mass (Phlegmon / Abscess)",
    "Appendiceal Mucocele / Neoplasm",
    "Ileocecal Tuberculosis",
    "Crohn Disease (Terminal Ileal Mass)",
    "Carcinoma Cecum / Ascending Colon",
    "Cecal Lymphoma",
    "Ovarian / Adnexal Mass (♀)",
    "Meckel's Diverticulum Complications",
  ], 1.0, 4.1, 8, 2.8, { fontSize: 13, color: C.light });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 7 — APPENDICULAR MASS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Appendicular Mass (Phlegmon / Abscess)", C.teal);
  categoryBadge(s, "INTRAPERITONEAL", C.teal);

  addBullets(s, [
    "Result of contained perforation of appendix → omentum + loops of bowel wall off the appendix",
    "Phlegmon: Solid inflammatory mass (no pus cavity)",
    "Abscess: Central liquefaction → pus cavity (surgical emergency if large / septic)",
    "Presents 3–5 days after onset of appendicitis",
  ], 0.3, 1.3, 6.0, 1.8, { fontSize: 12 });

  // 2 column below
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.15, w: 2.8, h: 0.35, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addText("CLINICAL FEATURES", { x: 0.3, y: 3.15, w: 2.8, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "RIF pain (dull aching → severe)",
    "Fever, tachycardia",
    "Palpable tender RIF mass",
    "Guarding/rigidity (if peritonitis)",
    "Leukocytosis, ↑CRP/ESR",
  ], 0.3, 3.55, 2.8, 2.0, { fontSize: 11 });

  s.addShape(pres.ShapeType.rect, { x: 3.3, y: 3.15, w: 2.8, h: 0.35, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
  s.addText("IMAGING", { x: 3.3, y: 3.15, w: 2.8, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "USG: Heterogeneous mass, non-compressible, ± abscess cavity, ± free fluid",
    "CT (gold standard): Periappendiceal fat stranding, wall thickening, abscess",
    "Appendicolith may be visible",
  ], 3.3, 3.55, 2.8, 2.0, { fontSize: 11 });

  addImageWithCaption(s, img(1), 6.4, 0.92, 3.3, 3.0, "USG — Appendicular mass with fluid (RIF phlegmon)");
  addImageWithCaption(s, img(2), 9.9, 0.92, 3.1, 3.0, "CT Axial — Periappendiceal abscess cavity");

  // management
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.7, w: 12.7, h: 0.35, fill: { color: C.dark }, line: { color: C.dark, width: 0 } });
  s.addText("OCHSNER-SHERREN REGIMEN (Conservative): NPO · IV antibiotics · IV fluids · 4-hourly vitals · Serial abdominal exam  →  Interval appendicectomy at 6–8 weeks", {
    x: 0.3, y: 5.7, w: 12.7, h: 0.35, fontSize: 10, color: C.white, align: "center", valign: "middle", fontFace: "Calibri",
  });

  addImageWithCaption(s, img(18), 6.4, 4.0, 6.6, 1.55, "USG — Periappendiceal phlegmon in pediatric patient");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 8 — APPENDICEAL MUCOCELE / NEOPLASM
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Appendiceal Mucocele & Appendiceal Neoplasms", C.teal);
  categoryBadge(s, "INTRAPERITONEAL", C.teal);

  addBullets(s, [
    "Mucocele: Dilatation of appendix lumen with mucin — spectrum from benign (retention cyst) to malignant (mucinous adenocarcinoma)",
    "Classified: Simple mucocoele → LAMN (Low-grade appendiceal mucinous neoplasm) → HAMN → Mucinous adenocarcinoma",
    "LAMN: Most common; rupture → pseudomyxoma peritonei (PMP) — 'jelly belly'",
    "Carcinoid tumor: Commonest appendiceal tumor; tip of appendix; < 2 cm usually benign",
    "Adenocarcinoma: Rare; presents as RIF mass ± obstruction",
  ], 0.3, 1.0, 6.5, 2.6, { fontSize: 11.5 });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.7, w: 6.5, h: 0.35, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addText("KEY MANAGEMENT POINTS", { x: 0.3, y: 3.7, w: 6.5, h: 0.35, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "CT: Cystic appendiceal mass, ± calcification in wall, ± pseudomyxoma peritonei",
    "No biopsy if mucocele suspected (risk of seeding)",
    "Rx: Laparoscopic appendicectomy (intact removal, no spillage); right hemicolectomy if base involved or adenocarcinoma",
    "PMP: HIPEC (hyperthermic intraperitoneal chemotherapy) ± cytoreductive surgery",
  ], 0.3, 4.1, 6.5, 2.1, { fontSize: 11 });

  addImageWithCaption(s, img(3), 7.1, 0.9, 5.9, 5.8, "CT — Appendiceal mucocele: well-defined cystic mass adjacent to cecum (red arrow)");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 9 — ILEOCECAL TUBERCULOSIS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Ileocecal Tuberculosis", C.teal);
  categoryBadge(s, "INTRAPERITONEAL", C.teal);

  addBullets(s, [
    "Commonest site of abdominal TB (80%) — ileocecal region due to abundant lymphoid tissue (Peyer's patches)",
    "Hyperplastic type: Inflammatory mass mimicking carcinoma or Crohn's disease",
    "Ulcerative type: Transverse ulcers → 'napkin ring' stricture",
    "Lymphadenopathic type: Mesenteric lymphadenopathy ± caseous necrosis",
    "Pathology: Caseating granulomas; AFB positive (variable); IGRA / Mantoux +ve",
  ], 0.3, 1.05, 6.3, 2.4, { fontSize: 11.5 });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.55, w: 3.0, h: 0.35, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addText("CT FEATURES", { x: 0.3, y: 3.55, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "Concentric cecal wall thickening",
    "Pulled-up / fibrosed cecum (shrunken)",
    "Necrotic mesenteric lymph nodes",
    "Calcified lymph nodes (pathognomonic)",
    "Responds to ATT on follow-up CT",
  ], 0.3, 3.95, 3.0, 2.1, { fontSize: 11 });

  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 3.55, w: 3.1, h: 0.35, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
  s.addText("MANAGEMENT", { x: 3.5, y: 3.55, w: 3.1, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "ATT × 6–9 months (HRZE × 2 → HR × 4)",
    "Surgery: Stricturoplasty or resection for obstruction",
    "Difficult to distinguish from Crohn / carcinoma",
    "Colonoscopy + biopsy essential",
    "Key differentiator from Crohn: +ve IGRA, caseating granuloma, response to ATT",
  ], 3.5, 3.95, 3.1, 2.1, { fontSize: 10.5 });

  addImageWithCaption(s, img(4), 6.9, 0.9, 6.1, 2.9, "Coronal CT — Cecal wall thickening (A); resolution after ATT (B)");
  addImageWithCaption(s, img(16), 6.9, 4.0, 3.0, 2.5, "CT — Cecal & ileal wall thickening + calcified nodes (↑TB)");
  addImageWithCaption(s, img(5), 10.1, 4.0, 3.0, 2.5, "Axial CT — Ileocecal TB: circumferential thickening, fat stranding");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 10 — CROHN DISEASE
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Crohn's Disease — Terminal Ileal Mass", C.teal);
  categoryBadge(s, "INTRAPERITONEAL", C.teal);

  addBullets(s, [
    "Transmural granulomatous inflammation; most commonly involves terminal ileum + ileocecal junction",
    "Presents as RIF mass in 30–40% — due to matted loops, mesenteric fat hypertrophy ('creeping fat'), phlegmon",
    "Skip lesions; cobblestone mucosa; rose-thorn ulcers; fistulae / sinus tracts",
    "Extra-intestinal: Arthritis, uveitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis",
  ], 0.3, 1.05, 6.2, 2.1, { fontSize: 11.5 });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.25, w: 3.0, h: 0.35, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addText("CT ENTEROGRAPHY", { x: 0.3, y: 3.25, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "Wall thickening (>4 mm) + mural hyperenhancement",
    "Comb sign (engorgement of vasa recta)",
    "Creeping fat / fibrofatty proliferation",
    "Abscess / fistula in penetrating disease",
    "String sign (Kantor) on barium follow-through",
  ], 0.3, 3.65, 3.0, 2.4, { fontSize: 11 });

  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 3.25, w: 3.0, h: 0.35, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
  s.addText("MANAGEMENT", { x: 3.5, y: 3.25, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "Medical: 5-ASA, steroids, azathioprine, anti-TNF (infliximab, adalimumab)",
    "Surgery: Ileocolic resection for stricture / abscess / fistula / failure of medical Rx",
    "Abscess: Percutaneous drainage + antibiotics → elective resection",
    "Stricturoplasty for short fibrous strictures",
  ], 3.5, 3.65, 3.0, 2.4, { fontSize: 11 });

  addImageWithCaption(s, img(6), 6.8, 0.92, 3.2, 3.2, "CT — Crohn's abscess in RIF with terminal ileal thickening (arrows & *)");
  addImageWithCaption(s, img(7), 10.1, 0.92, 3.0, 3.2, "CT — Comb sign + creeping fat in active Crohn's");
  addImageWithCaption(s, img(19), 6.8, 4.2, 6.3, 2.0, "CT — Ileocaecal complex mass with pericaecal collection; Crohn vs appendicitis vs TB");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 11 — CARCINOMA CECUM
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Carcinoma of the Cecum & Right Colon", C.teal);
  categoryBadge(s, "INTRAPERITONEAL", C.teal);

  addBullets(s, [
    "Right-sided colon cancer: Typically presents late — large fungating mass (insidious onset)",
    "Symptoms: Vague RIF pain, palpable mass, iron-deficiency anaemia (± occult bleeding), weight loss",
    "No obstructive symptoms early (wide lumen) — but may cause partial obstruction in advanced cases",
    "Risk factors: Age >50, FAP, HNPCC, IBD, high-fat low-fibre diet",
    "Tumour markers: ↑ CEA (monitoring, not diagnosis); colonoscopy + biopsy = definitive diagnosis",
  ], 0.3, 1.05, 6.2, 2.5, { fontSize: 11.5 });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.65, w: 3.0, h: 0.35, fill: { color: C.teal }, line: { color: C.teal, width: 0 } });
  s.addText("STAGING (TNM / DUKES)", { x: 0.3, y: 3.65, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  const dukes = [["A", "Mucosa / submucosa", "95%"], ["B", "Through muscularis propria", "65%"], ["C", "Lymph nodes positive", "35%"], ["D", "Distant metastasis", "5%"]];
  dukes.forEach(([d, desc, surv], di) => {
    const dy = 4.05 + di * 0.4;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: dy, w: 0.4, h: 0.37, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
    s.addText(d, { x: 0.3, y: dy, w: 0.4, h: 0.37, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(`${desc}  —  5-yr survival: ${surv}`, { x: 0.75, y: dy + 0.04, w: 2.55, h: 0.3, fontSize: 10, color: C.dark, fontFace: "Calibri" });
  });

  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 3.65, w: 3.0, h: 0.35, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
  s.addText("MANAGEMENT", { x: 3.5, y: 3.65, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "Right hemicolectomy (± extended) — gold standard",
    "Complete mesocolic excision (CME) for optimal nodal clearance",
    "Adjuvant chemo (FOLFOX / CAPOX) for Stage III/IV",
    "Laparoscopic approach: Equivalent oncological outcomes",
  ], 3.5, 4.05, 3.0, 1.85, { fontSize: 11 });

  addImageWithCaption(s, img(8), 6.8, 0.9, 3.3, 3.7, "CT — Cecal mass with wall thickening and lumen narrowing");
  addImageWithCaption(s, img(9), 10.2, 0.9, 2.8, 3.7, "Surgical specimen — right hemicolectomy for cecal carcinoma");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 12 — OVARIAN / ADNEXAL MASS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Ovarian & Adnexal Masses (Female Patients)", C.teal);
  categoryBadge(s, "INTRAPERITONEAL", C.teal);

  const otypes = [
    { name: "Ovarian Cyst / Torsion", color: C.teal, pts: ["Commonest in reproductive age", "Torsion: Acute RIF pain, vomiting,\ntender adnexal mass", "Whirlpool sign on CT/Doppler", "Rx: Emergency laparoscopy\n(detorsion ± oophorectomy)"] },
    { name: "Dermoid Cyst (Mature Teratoma)", color: C.orange, pts: ["Commonest ovarian tumour 15–30 yrs", "Contains fat, hair, teeth, sebaceous material", "USG: Mixed echogenicity, acoustic shadow", "Rx: Cystectomy (preserve ovary)"] },
    { name: "Tubo-ovarian Abscess", color: C.red, pts: ["PID complication — Nesseria, Chlamydia", "Bilateral tender adnexal masses", "Fever, vaginal discharge", "Rx: IV antibiotics; drainage if no response"] },
    { name: "Ectopic Pregnancy (Ruptured)", color: C.navy, pts: ["Amenorrhoea + RIF pain + haemoperitoneum", "+ve β-hCG; empty uterus on USG", "Adnexal mass ± free fluid in POD", "Surgical emergency: Salpingectomy"] },
  ];

  otypes.forEach((ot, i) => {
    const col = i < 2 ? i : i - 2;
    const row = i < 2 ? 0 : 1;
    const ox = 0.3 + col * 6.5;
    const oy = 1.0 + row * 3.0;
    s.addShape(pres.ShapeType.rect, { x: ox, y: oy, w: 6.2, h: 0.38, fill: { color: ot.color }, line: { color: ot.color, width: 0 } });
    s.addText(ot.name, { x: ox, y: oy, w: 6.2, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: ox, y: oy + 0.38, w: 6.2, h: 2.45, fill: { color: C.light }, line: { color: ot.color, width: 0.8 } });
    addBullets(s, ot.pts, ox + 0.1, oy + 0.45, 6.0, 2.2, { fontSize: 11 });
  });

  addImageWithCaption(s, img(10), 6.9, 1.0, 6.1, 2.75, "CT Coronal — Large right adnexal cyst with whirlpool sign (ovarian torsion)");
  addImageWithCaption(s, img(17), 6.9, 4.0, 6.1, 2.75, "Multimodal — Ovarian torsion: US whirl sign + CT + surgical specimen (dermoid)");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 13 — SECTION DIVIDER: RETROPERITONEAL
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.dark);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.6, h: "100%", fill: { color: C.purple }, line: { color: C.purple, width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0.6, y: 2.5, w: 12.7, h: 0.08, fill: { color: C.purple }, line: { color: C.purple, width: 0 } });

  s.addText("SECTION 3", { x: 1.0, y: 1.5, w: 8, h: 0.6, fontSize: 20, color: C.purple, bold: false, charSpacing: 5, fontFace: "Calibri" });
  s.addText("RETROPERITONEAL", { x: 1.0, y: 2.0, w: 11, h: 1.1, fontSize: 40, color: C.white, bold: true, fontFace: "Calibri" });
  s.addText("MASSES", { x: 1.0, y: 2.9, w: 10, h: 1.1, fontSize: 52, color: C.purple, bold: true, fontFace: "Calibri" });

  addBullets(s, [
    "Psoas Abscess (Primary & Secondary)",
    "Iliac Lymphadenopathy (Reactive / Metastatic / Lymphoma)",
    "Retroperitoneal Sarcoma (Liposarcoma / Leiomyosarcoma)",
    "Iliac Artery Aneurysm",
    "Undescended Testis (Ectopic testis in RIF)",
    "Retroperitoneal Fibrosis",
    "Iliac Bone Tumors / Metastases",
  ], 1.0, 4.1, 8, 2.8, { fontSize: 13, color: C.light });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 14 — PSOAS ABSCESS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Psoas Abscess", C.purple);
  categoryBadge(s, "RETROPERITONEAL", C.purple);

  addBullets(s, [
    "Primary psoas abscess: Haematogenous spread (Staphylococcus aureus) — common in immunocompromised, diabetics, IV drug users",
    "Secondary psoas abscess: Spread from adjacent structures — vertebral TB (Pott's disease), Crohn's disease, perinephric abscess, appendicitis, diverticulitis",
    "Classic triad: Fever + back/groin pain + RIF mass — only 30% present with full triad",
    "Psoas sign: Pain on passive extension of hip (hip held in flexion posture)",
    "Obturator sign: Pain on internal rotation of flexed hip (pelvic abscess)",
    "Fluctuant RIF mass that may point below inguinal ligament (cold abscess from TB spine)",
  ], 0.3, 1.05, 6.2, 3.0, { fontSize: 11.5 });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.15, w: 3.0, h: 0.35, fill: { color: C.purple }, line: { color: C.purple, width: 0 } });
  s.addText("MANAGEMENT", { x: 0.3, y: 4.15, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "CT-guided percutaneous drainage (first-line for primary abscess)",
    "IV antibiotics (anti-staphylococcal; anti-TB for secondary TB abscess)",
    "Surgical drainage if failed percutaneous / multiloculated",
    "Treat underlying cause (Crohn / TB spine)",
  ], 0.3, 4.55, 3.0, 2.0, { fontSize: 11 });

  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 4.15, w: 3.0, h: 0.35, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
  s.addText("INVESTIGATIONS", { x: 3.5, y: 4.15, w: 3.0, h: 0.35, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  addBullets(s, [
    "CT abdomen+pelvis with contrast — modality of choice",
    "Enlarged psoas muscle with central hypodensity, ± gas",
    "MRI: Superior for soft tissue involvement / spinal TB",
    "Blood cultures, pus C&S",
    "IGRA / Mantoux for TB",
  ], 3.5, 4.55, 3.0, 2.0, { fontSize: 11 });

  addImageWithCaption(s, img(11), 6.8, 0.92, 3.2, 3.2, "CT — Enlarged right psoas with hypodense abscess cavity");
  addImageWithCaption(s, img(12), 10.1, 0.92, 3.0, 3.2, "CT — Bilateral psoas abscesses (right >> left) with multi-loculations");
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 15 — ILIAC LYMPHADENOPATHY / RETROPERITONEAL SARCOMA
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Iliac Lymphadenopathy & Retroperitoneal Sarcoma", C.purple);
  categoryBadge(s, "RETROPERITONEAL", C.purple);

  const cards = [
    {
      title: "ILIAC LYMPHADENOPATHY",
      color: C.purple,
      pts: [
        "Reactive: Secondary to RIF region infection / appendicitis",
        "Lymphoma: NHL (most common) / Hodgkin's — painless discrete nodes; B-symptoms (fever, night sweats, weight loss)",
        "Metastatic: From colorectal, testicular, ovarian, prostate carcinoma",
        "CT: Multiple enlarged nodes >1 cm, ± necrosis (lymphoma: 'rubber-stamp' nodes); PET-CT for staging",
        "Biopsy: Image-guided core needle biopsy for tissue diagnosis",
        "Rx: Chemotherapy / radiotherapy (lymphoma); treat primary (metastatic)",
      ],
    },
    {
      title: "RETROPERITONEAL SARCOMA",
      color: C.navy,
      pts: [
        "Liposarcoma (most common) & Leiomyosarcoma",
        "Present as large, painless RIF / retroperitoneal mass",
        "MRI: Gold standard — fat signal (liposarcoma); heterogeneous enhancing mass",
        "Often large (>10 cm) at diagnosis",
        "Rx: En bloc radical resection (R0) — mainstay; adjuvant radiation for high-grade",
        "5-year survival: 50–60% (local recurrence common)",
      ],
    },
    {
      title: "ILIAC ARTERY ANEURYSM & OTHER",
      color: C.orange,
      pts: [
        "Iliac artery aneurysm: Pulsatile expansile RIF mass; bruit on auscultation",
        "CT-angiography: Confirms diagnosis; measures size",
        "Rx: Endovascular repair (EVAR) or open surgery if symptomatic / >3.5 cm",
        "Undescended testis: Firm, rubbery RIF mass in young male; inguinal or intraabdominal",
        "Risk: Malignant transformation (seminoma) — orchidopexy + surveillance",
        "Retroperitoneal fibrosis: Periaortic fibrosis; bilateral ureteric obstruction; IgG4-related",
      ],
    },
  ];

  cards.forEach((card, ci) => {
    const cx = 0.3 + ci * 4.35;
    s.addShape(pres.ShapeType.rect, { x: cx, y: 0.95, w: 4.15, h: 0.4, fill: { color: card.color }, line: { color: card.color, width: 0 } });
    s.addText(card.title, { x: cx, y: 0.95, w: 4.15, h: 0.4, fontSize: 9.5, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: cx, y: 1.35, w: 4.15, h: 5.8, fill: { color: C.light }, line: { color: card.color, width: 0.8 } });
    addBullets(s, card.pts, cx + 0.1, 1.42, 3.95, 5.6, { fontSize: 10.5 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 16 — DIFFERENTIAL DIAGNOSIS COMPARISON TABLE
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Differential Diagnosis Summary Table — RIF Mass", C.navy);

  const headers = ["Condition", "Key Feature", "Sign / Test", "Imaging", "Management"];
  const rows = [
    ["Rectus Sheath\nHematoma", "Fothergill's +ve\nAnticoag history", "Carnett's sign +ve", "CT: Hyperdense wall mass", "Conservative / Embolisation"],
    ["Appendicular\nMass/Abscess", "H/O appendicitis\n3–5 days", "Rebound/Guarding", "USG/CT: Periappendiceal\ninflammatory mass", "Ochsner-Sherren /\nInterval appendicectomy"],
    ["Ileocecal TB", "Hyperplastic mass\nChronic onset", "TB contact, Mantoux +ve", "CT: Shrunken cecum,\ncalcified nodes", "ATT 6–9 months ±\nSurgery"],
    ["Crohn Disease", "Skip lesions, fistulae\nYoung adult", "String sign (barium)", "CT: Comb sign,\ncreeping fat", "Biologics → Ileocolic\nresection"],
    ["Cecal Carcinoma", "Anaemia, weight loss\nAge >50", "↑CEA, colonoscopy", "CT: Enhancing mass,\nlymph nodes", "Right hemicolectomy\n± adjuvant chemo"],
    ["Ovarian Cyst /\nTorsion", "Female, acute pain\nMenstrual h/o", "β-hCG, β-USG; +ve\nAdnexal tenderness", "CT/USG: Whirlpool sign\nadnexal cyst", "Emergency laparoscopy\n(detorsion/oophorectomy)"],
    ["Psoas Abscess", "Fever + hip held\nin flexion", "Psoas sign +ve\nIGRA/Mantoux", "CT: Enlarged psoas\nhypodense collection", "CT-guided drainage +\nAntibiotics / ATT"],
    ["Iliac\nLymphadenopathy", "B-symptoms\nSystemic malaise", "PET-CT staging\nCore biopsy", "CT: Nodes >1 cm,\n± necrosis", "Chemo/Radiotherapy\n(Lymphoma)"],
    ["Spigelian Hernia", "Lateral rectus mass\nCough impulse +", "Defect at semi-\nlunar line", "CT: Fascial defect\nbowel herniation", "Laparoscopic / Open\nhernia repair"],
  ];

  const colWidths = [2.0, 2.3, 2.3, 2.6, 2.7];
  const startX = 0.3;
  const startY = 0.85;
  const rowH = 0.6;
  const headerH = 0.42;

  // header row
  let cx = startX;
  headers.forEach((h, hi) => {
    s.addShape(pres.ShapeType.rect, { x: cx, y: startY, w: colWidths[hi], h: headerH, fill: { color: C.navy }, line: { color: C.navy, width: 0 } });
    s.addText(h, { x: cx + 0.05, y: startY, w: colWidths[hi] - 0.1, h: headerH, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    cx += colWidths[hi] + 0.02;
  });

  rows.forEach((row, ri) => {
    const ry = startY + headerH + ri * rowH;
    const bgCol = ri % 2 === 0 ? C.light : C.white;
    let colx = startX;
    const rowColors = [C.orange, C.teal, C.teal, C.teal, C.teal, C.teal, C.purple, C.purple, C.orange];
    row.forEach((cell, ci) => {
      const isFirst = ci === 0;
      s.addShape(pres.ShapeType.rect, { x: colx, y: ry, w: colWidths[ci], h: rowH, fill: { color: isFirst ? rowColors[ri] : bgCol }, line: { color: C.gray, width: 0.3 } });
      s.addText(cell, {
        x: colx + 0.05, y: ry + 0.03, w: colWidths[ci] - 0.1, h: rowH - 0.05,
        fontSize: isFirst ? 9.5 : 9.5,
        color: isFirst ? C.white : C.dark,
        bold: isFirst,
        fontFace: "Calibri",
        valign: "middle",
        align: isFirst ? "center" : "left",
      });
      colx += colWidths[ci] + 0.02;
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 17 — CLINICAL APPROACH ALGORITHM
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Systematic Approach to RIF Mass — Algorithm", C.navy);

  // Flowchart using boxes + connectors
  function box(sl, x, y, w, h, text, fillColor, textColor = C.white, fSize = 11) {
    sl.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: fillColor }, line: { color: fillColor, width: 0 }, rectRadius: 0.06 });
    sl.addText(text, { x, y, w, h, fontSize: fSize, color: textColor, align: "center", valign: "middle", bold: true, fontFace: "Calibri" });
  }
  function arrow(sl, x1, y1, x2, y2) {
    sl.addShape(pres.ShapeType.line, { x: x1, y: y1, w: x2 - x1, h: y2 - y1, line: { color: C.gray, width: 1.5 } });
  }

  box(s, 4.5, 0.9, 4.3, 0.5, "RIF MASS DETECTED", C.navy, C.white, 13);
  arrow(s, 6.65, 1.4, 6.65, 1.65);

  box(s, 4.5, 1.65, 4.3, 0.55, "HISTORY & EXAMINATION\n(Carnett / Fothergill / Psoas sign)", C.teal, C.white, 10);
  arrow(s, 6.65, 2.2, 6.65, 2.5);

  box(s, 4.5, 2.5, 4.3, 0.5, "Carnett's sign POSITIVE?", C.orange, C.white, 11);

  // Yes branch — abdominal wall
  arrow(s, 4.5, 2.75, 2.0, 2.75);
  box(s, 0.3, 2.5, 1.7, 0.5, "YES", C.orange, C.white, 11);
  arrow(s, 1.15, 3.0, 1.15, 3.3);
  box(s, 0.3, 3.3, 3.5, 0.5, "ABDOMINAL WALL MASS\n→ USG / CT → Excision / Evacuate", C.orange, C.white, 9.5);

  // No branch — intraperitoneal/retroperitoneal
  arrow(s, 8.8, 2.75, 11.3, 2.75);
  box(s, 11.3, 2.5, 1.7, 0.5, "NO", C.teal, C.white, 11);
  arrow(s, 12.15, 3.0, 12.15, 3.3);

  arrow(s, 6.65, 3.0, 6.65, 3.3);
  box(s, 4.5, 3.3, 4.3, 0.5, "USG ABDOMEN & PELVIS\n(1st line imaging)", C.lblue, C.white, 10);
  arrow(s, 6.65, 3.8, 6.65, 4.1);
  box(s, 4.5, 4.1, 4.3, 0.5, "CECT ABDOMEN (Gold Standard)\n+ Tumour markers / IGRA / β-hCG", C.lblue, C.white, 10);
  arrow(s, 6.65, 4.6, 6.65, 4.9);

  // Branch out from CT
  // Intraperitoneal
  s.addShape(pres.ShapeType.line, { x: 4.5, y: 5.15, w: -3.0, h: 0, line: { color: C.gray, width: 1.5 } });
  box(s, 0.3, 4.9, 4.15, 0.5, "INTRAPERITONEAL\n(Appendix/Cecum/Ovary/IBD)", C.teal, C.white, 9.5);
  // Retroperitoneal
  s.addShape(pres.ShapeType.line, { x: 8.8, y: 5.15, w: 3.0, h: 0, line: { color: C.gray, width: 1.5 } });
  box(s, 8.8, 4.9, 4.15, 0.5, "RETROPERITONEAL\n(Psoas/Lymph nodes/Sarcoma)", C.purple, C.white, 9.5);

  box(s, 4.5, 4.9, 4.3, 0.5, "DIAGNOSIS CONFIRMED?", C.navy, C.white, 11);
  arrow(s, 6.65, 5.4, 6.65, 5.7);

  // Bottom row
  const finalBoxes = [
    ["Conservative\n(TB/Crohn)", C.teal, 0.3],
    ["Percutaneous\nDrainage (Abscess)", C.orange, 3.3],
    ["Surgical\nResection", C.red, 6.3],
    ["Chemo/Radio\n(Lymphoma)", C.purple, 9.3],
    ["Emergency\nLaparoscopy", C.navy, 11.0],
  ];
  finalBoxes.forEach(([t, c, fx]) => {
    arrow(s, 6.65, 5.7, fx + 0.8, 5.7);
    box(s, fx, 5.7, 1.9, 0.6, t, c, C.white, 9);
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 18 — KEY CLINICAL SIGNS
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Key Clinical Signs in RIF Mass", C.navy);

  const signs = [
    { sign: "Carnett's Sign", desc: "Pain INCREASES on tensing the rectus abdominis (abdominal wall origin vs intraperitoneal)", color: C.orange },
    { sign: "Fothergill's Sign", desc: "Mass does NOT cross midline and remains palpable when rectus is contracted (rectus sheath hematoma)", color: C.orange },
    { sign: "Psoas Sign", desc: "RIF pain on passive hip extension with knee straight — retrocaecal appendicitis / psoas abscess", color: C.purple },
    { sign: "Obturator Sign", desc: "RIF pain on internal rotation of flexed right hip — pelvic abscess / pelvic appendicitis", color: C.purple },
    { sign: "Rovsing's Sign", desc: "RIF pain on palpation of LIF — acute appendicitis (referred pain along iliocaecal mesentery)", color: C.teal },
    { sign: "McBurney's Point Tenderness", desc: "Maximum tenderness at 2/3rd from umbilicus to ASIS — classic appendicitis sign", color: C.teal },
    { sign: "Dance's Sign", desc: "Empty RIF on palpation — intussusception (ileocolic)", color: C.navy },
    { sign: "Grey-Turner's Sign", desc: "Flank bruising — retroperitoneal haemorrhage (haematoma tracking in retroperitoneum)", color: C.navy },
    { sign: "Sister Mary Joseph Nodule", desc: "Periumbilical metastatic nodule from intra-abdominal malignancy (gastric, colorectal, ovarian)", color: C.red },
    { sign: "Whirlpool Sign (CT/USG)", desc: "Twisting of vascular pedicle — pathognomonic of ovarian torsion", color: C.lblue },
    { sign: "Comb Sign (CT)", desc: "Engorgement of vasa recta (small bowel mesenteric vessels) — active Crohn's disease", color: C.lblue },
    { sign: "Napkin-Ring Sign (Ba Enema)", desc: "Circumferential annular constriction — carcinoma of colon", color: C.green },
  ];

  const perCol = 6;
  signs.forEach((sign, i) => {
    const col = i < perCol ? 0 : 1;
    const row = i % perCol;
    const sx = 0.3 + col * 6.65;
    const sy = 0.88 + row * 1.08;
    s.addShape(pres.ShapeType.rect, { x: sx, y: sy, w: 0.22, h: 0.9, fill: { color: sign.color }, line: { color: sign.color, width: 0 } });
    s.addShape(pres.ShapeType.rect, { x: sx + 0.22, y: sy, w: 6.2, h: 0.9, fill: { color: C.light }, line: { color: sign.color, width: 0.5 } });
    s.addText(sign.sign, { x: sx + 0.28, y: sy + 0.04, w: 5.9, h: 0.35, fontSize: 11, bold: true, color: sign.color, fontFace: "Calibri" });
    s.addText(sign.desc, { x: sx + 0.28, y: sy + 0.4, w: 5.9, h: 0.46, fontSize: 9.5, color: C.dark, fontFace: "Calibri" });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 19 — IMAGING APPROACH
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.white);
  addSlideHeader(s, "Imaging Approach to RIF Mass", C.navy);

  const modalities = [
    {
      name: "ULTRASONOGRAPHY (USG)",
      color: C.teal,
      role: "First-line investigation — cheap, no radiation, dynamic",
      features: [
        "Appendix: Non-compressible blind-end tube >6 mm = appendicitis",
        "Appendicular mass: Hyperechoic periappendiceal fat, abscess cavity",
        "Ovarian cyst: Size, morphology, Doppler flow; whirlpool sign in torsion",
        "Psoas abscess: Hypoechoic collection in psoas",
        "Wall: RSH — hypoechoic intramural collection; hernia defect",
      ],
      limitation: "Operator-dependent; bowel gas limits visualization",
    },
    {
      name: "CONTRAST CT ABDOMEN",
      color: C.navy,
      role: "Gold standard — best anatomical delineation",
      features: [
        "Appendiceal abscess: Periappendiceal stranding, rim-enhancing collection",
        "TB: Shrunken cecum, calcified mesenteric nodes, necrotic lymph nodes",
        "Crohn: Comb sign, creeping fat, wall thickening, fistulae",
        "Cecal carcinoma: Irregular enhancing mass, lymph nodes, liver mets",
        "Psoas: Enlarged psoas, hypodense collection, ± gas",
        "Retroperitoneal sarcoma: Heterogeneous large mass",
      ],
      limitation: "Radiation; contrast nephropathy risk",
    },
    {
      name: "MRI",
      color: C.purple,
      role: "Superior soft tissue detail; no radiation; MR Enterography for IBD",
      features: [
        "Crohn: MR Enterography — mural hyperenhancement, fistulae",
        "Desmoid: T2 hypointense (hallmark)",
        "Retroperitoneal sarcoma: Tissue characterization",
        "Psoas abscess: Extent, spinal involvement (Pott's disease)",
        "Ovarian masses: Complex morphology, T1 fat-sat for dermoid",
      ],
      limitation: "Expensive; time-consuming; bowel motion artefact",
    },
    {
      name: "BARIUM ENEMA / FOLLOW-THROUGH",
      color: C.orange,
      role: "Dynamic mucosal assessment — largely superseded by CT/endoscopy",
      features: [
        "String sign of Kantor — Crohn's stricture of terminal ileum",
        "Napkin-ring sign — carcinoma colon",
        "Caecal filling defect — carcinoma / hyperplastic TB mass",
        "Bird's beak / claw sign — intussusception",
        "Reversed 3 sign — annular carcinoma",
      ],
      limitation: "No information on adjacent organs; poor sensitivity",
    },
  ];

  modalities.forEach((mod, mi) => {
    const mx = 0.3 + (mi % 2) * 6.5;
    const my = 0.85 + Math.floor(mi / 2) * 3.3;
    s.addShape(pres.ShapeType.rect, { x: mx, y: my, w: 6.2, h: 0.38, fill: { color: mod.color }, line: { color: mod.color, width: 0 } });
    s.addText(mod.name, { x: mx, y: my, w: 6.2, h: 0.38, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: mx, y: my + 0.38, w: 6.2, h: 2.75, fill: { color: C.light }, line: { color: mod.color, width: 0.8 } });
    s.addText(`Role: ${mod.role}`, { x: mx + 0.1, y: my + 0.42, w: 6.0, h: 0.4, fontSize: 10, italic: true, color: mod.color, bold: true, fontFace: "Calibri" });
    addBullets(s, mod.features, mx + 0.1, my + 0.85, 6.0, 1.8, { fontSize: 10.5 });
    s.addText(`⚠ Limitation: ${mod.limitation}`, { x: mx + 0.1, y: my + 2.7, w: 6.0, h: 0.35, fontSize: 9.5, italic: true, color: C.red, fontFace: "Calibri" });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 20 — TAKE HOME MESSAGES
// ─────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bgFill(s, C.navy);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.75, fill: { color: C.dark }, line: { color: C.dark, width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.75, w: "100%", h: 0.08, fill: { color: C.gold }, line: { color: C.gold, width: 0 } });
  s.addText("TAKE HOME MESSAGES — RIF Mass", {
    x: 0.3, y: 0, w: 12.7, h: 0.75,
    fontSize: 22, bold: true, color: C.white, valign: "middle", fontFace: "Calibri",
  });

  const msgs = [
    { n: "1", t: "Systematic Anatomical Approach", d: "Always categorize: Abdominal Wall → Intraperitoneal → Retroperitoneal. Use Carnett's test to differentiate wall from visceral origin." },
    { n: "2", t: "History is Half the Diagnosis", d: "Age, sex, duration, fever, weight loss, TB contact, menstrual history, and prior surgery narrow the differential dramatically." },
    { n: "3", t: "Appendicular Mass — Ochsner-Sherren", d: "Do not operate on an appendicular mass acutely. Conservative management + interval appendicectomy at 6–8 weeks is standard practice." },
    { n: "4", t: "TB vs Crohn vs Carcinoma — The Great Mimics", d: "These three are the most difficult to distinguish. Mantoux/IGRA, colonoscopic biopsy, and response to ATT guide diagnosis. CT and MRI are essential." },
    { n: "5", t: "Imaging Strategy", d: "USG first (no radiation, cheap) → CECT abdomen (gold standard) → MRI for soft tissue/IBD. Never skip CT if malignancy is suspected." },
    { n: "6", t: "Female RIF — Always Consider Gynaecological", d: "β-hCG (rule out ectopic pregnancy), pelvic USG, and gynaecology review are mandatory in women of reproductive age with RIF mass." },
    { n: "7", t: "Psoas Abscess — Don't Miss", d: "Hip held in flexion + Psoas sign + fluctuant RIF mass = psoas abscess until proven otherwise. CT-guided drainage is first-line treatment." },
    { n: "8", t: "Malignancy Must Always Be Excluded", d: "Age >50, anaemia, weight loss, ↑CEA → exclude cecal carcinoma. Colonoscopy + biopsy is essential even after CT diagnosis." },
  ];

  msgs.forEach((msg, mi) => {
    const col = mi < 4 ? 0 : 1;
    const row = mi % 4;
    const bx = 0.3 + col * 6.5;
    const by = 0.95 + row * 1.6;
    s.addShape(pres.ShapeType.roundRect, { x: bx, y: by, w: 6.2, h: 1.45, fill: { color: C.dark }, line: { color: C.gold, width: 0.8 }, rectRadius: 0.06 });
    s.addShape(pres.ShapeType.roundRect, { x: bx, y: by, w: 0.5, h: 1.45, fill: { color: C.gold }, line: { color: C.gold, width: 0 }, rectRadius: 0.06 });
    s.addText(msg.n, { x: bx, y: by, w: 0.5, h: 1.45, fontSize: 18, bold: true, color: C.navy, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(msg.t, { x: bx + 0.55, y: by + 0.1, w: 5.6, h: 0.4, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri" });
    s.addText(msg.d, { x: bx + 0.55, y: by + 0.52, w: 5.6, h: 0.85, fontSize: 10, color: C.light, fontFace: "Calibri" });
  });
}

// ─────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────
const outputPath = "/home/daytona/workspace/rif-mass-ppt/RIF_Mass_DDx.pptx";
pres.writeFile({ fileName: outputPath }).then(() => {
  console.log("✅ Presentation saved:", outputPath);
}).catch(err => {
  console.error("❌ Error:", err);
  process.exit(1);
});