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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0004-CONDITIONS OF ORGAN SYSTEMS (PART I)

Background reading material for medicine and fiqh panel held on 15th April 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA by Professor Omar Hasan Kasule Sr.

14.3.1 URO-GENITAL SYSTEM

A. Disorders Of The Urinary Tract

B. Disorders Of The Male Genital Tract

C. Disorders Of The Female Genital Tract

D. Infertility

E. Pregnancy, Delivery And Their Disorders

 

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 Vessels

C. Locomotor System

D. Muscles

E. Other Connective Tissues

 

14.3.4 ALIMENTARY SYSTEM

A. GIT Diseases

B. Ibadat

C. Aadaat

D. Muamalaat

E. Others

 

14.3.5 THE SENSORY SYSTEM

A. The Visual System

B. The Auditory System

C. Chemical Sensation

D. Surface Sensory System

E. Others

 

14.3.1 URO-GENITAL SYSTEM

A. DISORDERS OF THE URINARY TRACT

HEMATURIA:

Wudhu with hematuria

Fasting in hematuria of sufficient amount to cause anemia

 

RENAL FAILURE:

Saum in renal failure

 

UROLITHIASIS

Pain triggered by physical movements in salat

Stress of hajj movements and triggering pain

Fasting and stone formation

 

NEOPLASMS

Types:  renal carcinoma, transitional cell carcinoma of the bladder, cancer of the prostate

Hamaturia and wudhu

Leaking urine

 

URETER:

Disorders: stone, obstruction (spasm)

Salat

Saum

 

B. DISORDERS OF THE MALE GENITAL TRACT

SEXUAL DYSFUNCTION

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

 

PROSTATE

BPH and incomplete urinary voiding, incompetence

Carcinoma of the prostate causing hematuria

 

PENIS

Genital hygiene and prevention of cancer

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 TRACT

SEXUAL DYSFUNCTION

Loss of libido & enjoyment, dyspareunia, vaginismus: marriage and divorce

 

BLEEDING DISORDERS

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 ‘spotting’

Munakahaat: DUB and sexual relations. Iddat for the post menopausal woman.

 

CONGENITAL ANOMALIES

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

 

INFECTIONS

Cervix: infertility

Uterus: infertility

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:

Neoplasms of the ovary: treatment destroys reproductive function

Uterine fibroids lead to infertility, abortion, and bleeding. May have to be treated by hysterectomy

Adenomyositis:

Endometriosis leads to pain and infertility

 

ATROPHIC DISEASES:

 

BREAST:

Types of disorders: galactorrhoea, mastitis, carcinoma

Diseases and disorders of breast and effect on breast feeding. Mastitis, carcinoma.

Radical mastectomy has cosmetic effects that can affect marital relation

 

ANOVULATION

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. Behavioral disorders.

 

DISORDERS OF GENDER DIFFERENTIATION and GENDER IDENTITY

Anatomical and physiological: hermaphroditism

Physiological: virilization due to hormonal disorders

Behavioral: takhannuth: effeminate men is a major sin, istirjaal (masculine female is one of the kabair)

Marriage and inheritance in indeterminate gender

 

D. INFERTILITY

DEFINITION

Failure to get pregnant after 1 year of regular intercourse. Involuntary infertility can be primary or secondary

 

CAUSES

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

 

DIAGNOSIS

Documentation of ovulation

Evaluation of ovulation: basal body temperature, serum progesterone, endometrial biopsy

Semen analysis

Tubal-uterine evaluation: HSG (hysterosalpingo-oophorectomy); laparascopy

Post-coital tests

Sperm antibodies

 

TREATMENT OF MALE INFERTILITY

Repair varicocele

Vaso-epidydimostomy

Vasostomy

Repair ejaculatory duct obstruction

Treat ejaculatory disorders: eg retrograde ejaculation

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 gestation

IVF and embryo transfer

Psychological management

 

LEGAL RULINGS

Infertility as basis for nullification of marriage

 

E. PREGNANCY, DELIVERY AND THEIR DISORDERS

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.

 

POST-PARTUM COMPLICATIONS

Infection and bleeding disorders

Post-partum depression

 

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.

Drowning, gharaq:

 

B. DISEASE of BLOOD VESSELS

HYPERTENSION

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 functional recovery.

 

CORONARY ARTERY DISEASE

Physical exertion in salat, hajj and coitus may trigger a coronary attack.

 

ANEURYSM

Physical exertion may lead to rupture of an aneurysm

 

OCCLUSIVE ARTERIAL DISEASE

Wudhu with cold water may trigger symptoms of Raynaud’s disease.

 

VENOUS 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.

 

PERICARDITIS

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 anginal attack.

 

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)

PATHO-PHYSIOLOGY

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

 

MUAMALAT:

 

QADHA:

 

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 bandaged.

 

Phlebitis, thrombophlebitis: tayammum may have to be considered instead of wudhu. Sitting down in tashahhud may be difficult.

 

C. LOCOMOTOR SYSTEM

BONY SKELETON

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 bony skeleton.

 

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 difficult.

 

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 of wudhu.

 

Malignant neoplasm:

 

Osteoporosis: care has to be taken in movements in salat and hajj to avoid fractures

 

CARTILAGE

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.

 

JOINTS

Salaat al awaabiin wa al fisaal (KS 318).

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.

 

D. MUSCLES

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 in salat

 

Go to Part II

Professor Omar Hasan Kasule 2000