14.3.1 URO-GENITAL SYSTEM
A. Disorders Of The Urinary Tract
B. Disorders Of The Male Genital
C. Disorders Of The Female Genital
E. Pregnancy, Delivery And Their
14.3.2 CARDIO-RESPIRATORY SYSTEM
A. Respiratory Disorders
B. Disease Of Blood Vessels
C. Diseases Of The Heart
D. Circulatory Failure (Shock)
14.3.3 CONNECTIVE TISSUE SYSTEM
A. Hematopoietic System (Dam)
B. Arteries, Veins, And Lymphatic
C. Locomotor System
E. Other Connective Tissues
14.3.4 ALIMENTARY SYSTEM
A. GIT Diseases
14.3.5 THE SENSORY SYSTEM
A. The Visual System
B. The Auditory System
C. Chemical Sensation
D. Surface Sensory System
14.3.1 URO-GENITAL SYSTEM
A. DISORDERS OF THE URINARY TRACT
Wudhu with hematuria
Fasting in hematuria of sufficient
amount to cause anemia
Saum in renal failure
Pain triggered by physical movements
Stress of hajj movements and triggering
Fasting and stone formation
Types: renal carcinoma, transitional cell carcinoma of the bladder, cancer of the prostate
Hamaturia and wudhu
Disorders: stone, obstruction (spasm)
B. DISORDERS OF THE MALE GENITAL
Loss of libido: marriage with no
sexual desire. Lack of libido as grounds for divorce of khulu’u
Impotence: nullification of marriage
after a grace period of 1 year to try to recover function
Ejaculation: pre-mature, delayed,
or no ejaculation as grounds for divorce
Priapism: physical harm to the spouse
Excessive sexual desire in one spouse
and not the other
BPH and incomplete urinary voiding,
Carcinoma of the prostate causing
Genital hygiene and prevention of
Circumcision and prevention of cancer
Proper cleaning under the prepuce
for the uncircumcised
TESTIS and VAS
Testicular torsion is a urologic
emergency. Its pain is so severe that it can lead to delay of salat.
Epidydimitis is an emergency that
may delay salat
Testicular cancer: treatment may
destroy reproductive function. Marriage and divorce
Cryptorchidism: Marriage and divorce
C. DISORDERS of THE FEMALE GENITAL
Loss of libido & enjoyment, dyspareunia,
vaginismus: marriage and divorce
Types: Menstrual, Pre-menopausal,
Post-menopausal, and DUB (may be anovulatory due to hormonal causes or ovulatory due to organic causes)
Wudhu and salat: Menorrhaghia and
passing through the masjid. Pre-menopausal and post-menopausal ‘spotting’.
Hajj: Pre-menopausal and post-menopausal
Munakahaat: DUB and sexual relations.
Iddat for the post menopausal woman.
Vagina: septate or imperforate vagina
preventing marriage consummation
Cervix: disorders cause infertility
or frequent abortions
Uterus: disorders that prevent implantation
lead to infertility
Fallopian tubes: Tubal infection
is a common cause of infertility
Ovaries: infertility, hormonal disorders
that affect behavior
Tubal obstruction: due to infection,
inflammation and post surgical. Leads to ectopic pregnancy
Legal liability of husband for transmission
of infection to wife
Can infertility be justification
for taking a second wife?
Neoplasms of the ovary: treatment
destroys reproductive function
Uterine fibroids lead to infertility,
abortion, and bleeding. May have to be treated by hysterectomy
Endometriosis leads to pain and infertility
Types of disorders: galactorrhoea,
Diseases and disorders of breast
and effect on breast feeding. Mastitis, carcinoma.
Radical mastectomy has cosmetic effects
that can affect marital relation
Has three causes: (a) CNS: hypothalamus:
tumors, trauma, vascular (b) Pituitary: tumors (c) Stress, anorexia nervosa, pseudocyesis, bulimia (c) Thyroid: hypo and hyper
(d) Ovarian disorders
HIRSUTISM due to androgen excess.
DISORDERS OF GENDER DIFFERENTIATION
and GENDER IDENTITY
Anatomical and physiological: hermaphroditism
Physiological: virilization due to
Behavioral: takhannuth: effeminate
men is a major sin, istirjaal (masculine female is one of the kabair)
Marriage and inheritance in indeterminate
Failure to get pregnant after 1 year
of regular intercourse. Involuntary infertility can be primary or secondary
Male factors: sperm anomalies, reduced
sperm mobility, few sperms
Female factors: anovulatory dysfunction,
tubo-peritoneal disease, and cervical disease
Others: advanced age, lower coital
frequency, immune factors male or female
Documentation of ovulation
Evaluation of ovulation: basal body
temperature, serum progesterone, endometrial biopsy
Tubal-uterine evaluation: HSG (hysterosalpingo-oophorectomy);
TREATMENT OF MALE INFERTILITY
Repair ejaculatory duct obstruction
Treat ejaculatory disorders: eg retrograde
Immune suppression for sperm antibody
Assisted reproductive techniques:
intra-uterine insemination, gamete intra-fallopian tube transfer
TREATMENT OF FEMALE INFERTILITY
Ovulation induction may lead to multiple
IVF and embryo transfer
Infertility as basis for nullification
E. PREGNANCY, DELIVERY AND THEIR
COMPLICATIONS OF EARLY PREGNANCY
Maternal rubella infection leads
to congenital anomalies in the fetus.
Recurrent pregnancy loss: primary
and secondary. It may be spontaneous, incomplete, and missed (fetus retained after its death). Causes: (a) genetic, endocrinogenic,
anatomic, immunologic, microbiological. Spontaneous abortion and post-abortion nifaas. Abortion may be complete, incomplete,
and recurrent. Pregnancy loss may be a cause of stress in a family anxious about having a baby.
COMPLICATIONS OF LATE PREGNANCY
Diseases of hemostasis and pregnancy.
COMPLICATIONS OF LABOR
Pregnancy may be post-term necessitating
induction of labor. Delivery complication may lead to difficult choices between saving one of the lives: mother or infant.
Infection and bleeding disorders
14.3.2 CARDIO-RESPIRATORY SYSTEM
A. RESPIRATORY DISORDERS
UPPER RESPIRATORY DISORDERS
Types of disorders: infections and
allergies such as rhinitis, throat clearings, sinusitis
Salat: A person with URTI can be
excused from leading salat because of difficulty in recitation of the Qur’an. Patients who are actively secreting virus
or bacteria should preferably pray at home.
Hajj: Isolation and other forms of
restriction may have to be applied for fear of spreading infection during hajj.
Social etiquette: patients with URTI
should restrict their social interaction for example visiting others so that infection does not spread. Clearing of the throat
and spitting is a bad unhygienic habit that should be discouraged.
LOWER RESPIRATORY DISORDERS
Types: bronchiectasis, lung abscess,
TB, lung cancer
Dyspnoea: acute and chronic respiratory infections, pneumothorax: salat, hajj
Cough: repetitive cough may make
recitation in salat difficult. ? Hemoptysis and repetition of wudhu.
Pain: Patients with pneumonia or
pneumonitis will experience pain on recitation and prostration.
Respiratory support: patients on
respiratory support can not recite Qur’an during salat.
B. DISEASE of BLOOD VESSELS
Orthostatic hypotension: Lowering
of blood pressure on prolonged standing necessitates shortening the recitation to avoid standing for a long time. Prolonged
sitting between prostrations may also be carried out. Rites of hajj like tawaaf will require frequent rest periods.
Cerebro-vascular disease: Syncope
can occur as part of stroke and may necessitate delay of salat and hajj rites. Judicial proceedings have to be suspended until
CORONARY ARTERY DISEASE
Physical exertion in salat, hajj
and coitus may trigger a coronary attack.
Physical exertion may lead to rupture
of an aneurysm
OCCLUSIVE ARTERIAL DISEASE
Wudhu with cold water may trigger
symptoms of Raynaud’s disease.
Phlebitis: wudhu with water may exacerbate
phlebitic symptoms. Tayammum is recommended in such cases.
Varicose veins: wudhu with water
may be uncomfortable necessitating tayammum.
Emboli: Care has to be taken to make
sure that physical movements in salat and hajj do not lead to dislodging an embolus
B. DISEASES OF THE HEART
CONGENITAL HEART DISEASE
Congenital heart disease may take
3 main forms: left to right shunts, right to left shunts, and congenital valve stenosis. The decision for surgical treatment
must weigh the benefits against the risk in such young patients. Since these diseases have a large genetic component, decisions
have to be made about having more children.
ACQUIRED VALVULAR DISEASE
The aortic valve may have stenosis
or incompetence. The mitral valve may have stenosis or regurgitation. In either case care must be taken that physical exertion
in salat and hajj does not lead to more severe decompensation.
Restrictive pericarditis limits cardiac
function. Care has to be taken in physical exertion in salat and hajj not to exacerbate the condition.
ISCHEMIC HEART DISEASE
The pain of ischemic heart disease
is so severe that it may necessitate delaying salat. Anginal pain may be triggered by exertion especially in hajj. Those with
a history of myocardial infarction should take care in physical exertion in salat and hajj. Sexual exertion may trigger an
CONGESTIVE CARDIAC FAILURE
Salat: Patients in CCF may be too
weak to pray. Standing up for prolonged periods in salat may worsen the lower leg edema and compromise venous return even
further. The muscle movements of salat may however have a beneficial effect in venous return. Hajj: Hajj is better postponed
in CCF because the patient may not be able to withstand the extra physical exertion involved.
D. CIRCULATORY FAILURE (SHOCK)
There are 4 main types of shock:
hypovolemic,cardiogenic, septic, and neurogenic. The causes of shock are: endocrine, metabolic respiratory, cardiac, vascular,
GIT, gynecological, obstetric, and neurological disorders. Dehydration and hemorrhage can also cause shock. Resusciation in
shock has 5 main elements: patwency of the airway, restoration of breathing and blood circulation, removing the disability,
and exposure. The following are monitored during treatment: pulse rate, respiratory rate, blood pressure, pulse pressure,
capillary refill time, temperature, urinary output, CVP, blood gases, and blood sugar. Specific treatment of shock is by blood
transfusion and IV fluids.
IBADAT: In states of shock the physical
movements of salat and hajj are not possible. Fasting is not allowed because of the need to replace body fluids.
AADAAT: A patient in shock may not
be able to feed in the conventional way. IG feeding and IV fluids may be necessary
14.3.3 CONNECTIVE TISSUE SYSTEM
HEMATOPOIETIC SYSTEM (DAM)
Anaemia is common in pregnancy. It
is obligatory for the mother to take haematinics as directed in the interests of the fetus
It is obligatory on parents to provide
sufficient nutrition to the infant to prevent anemia. Although breast-feeding is recommended for 2 years, it is not sufficient
by itself after the 6th month.
ARTERIES, VEINS, and LYMPHATIC VESSELS
Peripheral vascular disease: patients
with intermittent claudification may have to be careful in wudhu with very cold water. They also have to be careful in their
movements during salat.
Elephantitis: Wudhu may be difficult
especially if there are blisters and tayammum may have to be considered. It may not be possible to sit down in salat because
of the size of the enlarged lower limb.
DVT and salat: Movements of the lower
limb in salat may have to be limited when it is feared that an embolus may be released.
Varicose veins and wudu: tayammum
may have to be considered in place of wudhu if water will cause pain or there are blisters and wounds or when the limb is
Phlebitis, thrombophlebitis: tayammum
may have to be considered instead of wudhu. Sitting down in tashahhud may be difficult.
C. LOCOMOTOR SYSTEM
Disorders: The following are common
congenital anomalies: dysplasia (achondroplasia & osteogenesis imperfecta); cerebral palsy due to neuronal injury; congenital
club foot (talipes equinovarus); bow leg (genu varum; knock knee (genu valgum); developmental dysplasia of the hip joint;
and scoliosis. They may limit the range of movements in salat. Fractures and various types of arthritis may also affect the
Neck problems: The sideways movement of the neck in tasliim may be limited.
Upper limb: raising the hands in takbir may be restricted in cases of fractures and arthritis. Pointing with
the index finger is required in tashahhud (KS 320). It is forbidden to point with more than one finger (KS 320) or to intertwine
fingers (KS 320).
Lower limb: The prophet described the method of bowing, kaifa yakuun al ruku’u (KS 319). In lower limb
pathology bowing can be restricted. Prostration is also difficult since it
requires flexion at both the hip and the knee joints. Tawaaf in hajj may be difficult with lower limb pathology. It is allowed
to be supported by a stick or a pillar in salat (KS 321).
Back problems: Pain and restricted movements of the vertebral column make bowing more difficult. Standing for
prolonged periods may also be difficult. It is required that the back be straightened after bowing, istiwa al dhahar fi al
rukuu’I (KS 320); this is not possible in cases of back pathology. Back pain may interfere with sexual function.
Knee problems: The prophet described the manner of sitting in salat, kaifa yakuun al juluus (KS 319). Sitting
is required between every two prostrations, al juluus bayna kulli sajdatayn (KS 320) as well as in the last raka’a (KS
319). Restricted bending of the knees interferes with sitting properly. Knee problems may make tawaaf and sa’ay in hajj
Ankle problems: The prophet taught the proper way of placing the feet in sitting down, la yasaffu bayna qadamayhi
(KS 320). These may not be possible with ankle problems.
Fractures & sprains: Wudhu may not be possible with open wounds and compound fractures and resort is made
to tayammum. Pain due to sprains and fractures may limit movements in salat. Movements will not be possible at all when the
limbs are immobilized. When a pilgrim has a fracture or becomes lame for any other reason, he is discharged from the rites
of hajj and has to repeat the hajj later (KS 182).
Orthopedic fixation: Orthopedic fixation of some joints like the hip or knee joints may limit the range of movements
possible in salat. In hajj tawaaf may have to be done in a wheel-chair.
Osteomyelitis: Pain may limit movements in salat. If there is a discharging wound, tayammum will be needed instead
Osteoporosis: care has to be taken in movements in salat and hajj to avoid fractures
Oropharynx: Laryngeal, pharyngeal,
or other oral disease may impair ability to recite the Qur’an and thus lead others in prayer. Public duties like leadership
that require communication may be impaired. Pleas and evidence in court may also be affected.
Salaat al awaabiin wa al fisaal (KS
Osteoarthritis and rheumatoid arthritis
cause pain and limitation of movement. These limit the physical actions needed for salat and hajj
Degenerative disorders of the vertebral
column: spondylosis (arthritis of the spine), intervertebral disc disease (herniation), spondylolisthesis (anterior displacement)
impair ability to stand for long periods in salat as well as tawaaf and sa’ay.
Injury to muscles will necessitate
limitation of movements in salat while they heal.
E. OTHER CONNECTIVE TISSUES
Skin lesions: Skin lesions such as
eczema, dermatitis, itch, discharges, rashes, and chronic ulcer are a reason
for tayammum. If the skin is bandaged, the bandage is wiped with the wet hand
Hair: ihraam with insects in hair
INJURY TO LIGAMENTS
Injury to ligaments may limit movements
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