Got it.

You want the causes (etiology) added to the concise definitions, signs, and symptoms
for each topic.
I will go through each section again, this time including Definition, Causes (Etiology), Signs,
and Symptoms.

9. Cellular Responses to Stress & Injury

(a) Cell Injury (Reversible & Irreversible)
●​ Definition: Cell injury occurs when cells are exposed to stress that exceeds their
adaptive capacity, leading to functional and structural changes. It can be reversible (cell
recovers if stress is removed) or irreversible (leads to cell death).
●​ Causes (Etiology): Hypoxia/Ischemia, physical agents (trauma, heat), chemical
agents/drugs, microbial agents, immunological reactions, genetic derangements,
nutritional imbalances.
●​ Signs:
○​ Reversible: Cellular swelling (hydropic change), fatty change (steatosis), plasma
membrane blebbing, mitochondrial swelling, and clumping of nuclear chromatin
(visible microscopically).
○​ Irreversible: Loss of nuclear staining (pyknosis, karyorrhexis, karyolysis), rupture
of cell membranes, presence of myelin figures, and amorphous densities in
mitochondria (visible microscopically).
●​ Symptoms: Direct symptoms of early cell injury are often non-specific or absent.
Symptoms typically relate to the organ dysfunction caused by widespread cell injury (e.g.,
chest pain in myocardial ischemia).
○​ Cloudy Swelling:
■​ Definition: Swelling of cells due to water influx, making the cytoplasm appear
cloudy or vacuolated.
■​ Causes: Impaired cellular energy production (ATP depletion), leading to
failure of ion pumps. Common in hypoxia, chemical injury.
■​ Signs: Cells are enlarged, pale cytoplasm, with small, clear vacuoles
microscopically. Grossly, the affected organ might appear slightly enlarged
and pale.
■​ Symptoms: Generally no specific symptoms attributed solely to cloudy
swelling unless widespread.
○​ Steatosis (Fatty Change):
■​ Definition: Reversible accumulation of triglycerides within the cytoplasm of
parenchymal cells, commonly in the liver.
■​ Causes: Imbalances in fat metabolism, excessive fat intake/mobilization,
decreased fatty acid oxidation (e.g., alcohol abuse), impaired lipoprotein
synthesis/export.
■​ Signs: Lipid vacuoles seen microscopically, often displacing the nucleus.
Grossly, affected organs (e.g., liver) are enlarged, yellow, and greasy.
■​ Symptoms: Often asymptomatic, especially early. Severe cases of hepatic
steatosis can cause mild right upper quadrant discomfort or fatigue.
○​ Necrosis:
■​ Definition: Pathological cell death in living tissue, resulting from severe,
irreversible injury, characterized by enzymatic digestion of dead cells and
often an inflammatory response.
 ■​ Causes: Severe ischemia, bacterial infections, toxins, burns, severe trauma.
■​ Signs: Characteristic microscopic changes vary by type (e.g., ghost cells in
coagulative, amorphous debris in caseous, absence of tissue architecture).
Gross appearance depends on organ and type (e.g., firm and pale in
coagulative, viscous liquid in liquefactive).
■​ Symptoms: Depend on the affected organ (e.g., severe chest pain in
myocardial infarction, neurological deficits in stroke). General symptoms can
include fever and malaise due to inflammation.
○​ Gangrene:
■​ Definition: A macroscopic term for necrotic tissue, typically affecting limbs or
internal organs, often due to critical ischemia, frequently compounded by
bacterial infection.
■​ Causes: Severe ischemia (e.g., atherosclerosis, embolism, diabetes),
bacterial infection, trauma.
■​ Signs:
■​ Dry Gangrene: Affected area is cold, dry, shrunken, dark brown to
black (mummified), with no pulse, and a clear demarcation line.
■​ Wet Gangrene: Swollen, moist, soft, cold, dark-red to black, often with
blisters and purulent discharge, spreading rapidly without clear
demarcation.
■​ Gas Gangrene: Swelling, pain, crepitus (crackling under skin),
hemorrhagic bullae, bronze skin discoloration.
■​ Symptoms:
■​ Dry Gangrene: Gradual onset of coldness, numbness, and severe
pain, eventually mummification.
■​ Wet Gangrene: Rapid onset, severe pain, foul-smelling discharge,
systemic symptoms like fever and sepsis.
■​ Gas Gangrene: Rapidly spreading severe pain, high fever, rapid
progression to sepsis.
○​ Infarction:
■​ Definition: An area of ischemic necrosis caused by occlusion of either the
arterial supply or venous drainage in a particular tissue or organ.
■​ Causes: Arterial occlusion (thrombosis, embolism, vasculitis, spasm) or
venous occlusion.
■​ Signs: Vary by organ (e.g., ECG changes in myocardial infarction, focal
neurological deficits in cerebral infarction). Grossly, the lesion is often
wedge-shaped.
■​ Symptoms: Varies widely depending on the organ (e.g., crushing chest pain
in myocardial infarction, sudden neurological deficits in stroke, pleuritic chest
pain in pulmonary infarction).
(b) Cellular Adaptation
●​ Definition: Reversible changes in cells in response to environmental stress, allowing
them to survive and maintain function by reaching a new steady state.
●​ Causes (Etiology): Various physiological or pathological stresses.
●​ Signs: Observable changes in cell size, number, or type, often visible microscopically.
●​ Symptoms: Often relate to changes in organ function, or may be asymptomatic if
adaptation is effective.
○​ Atrophy:
 ■​ Definition: A reduction in the size of an organ or tissue due to a decrease in
cell size and/or number, leading to diminished function but not cell death.
■​ Causes: Disuse, denervation, ischemia/reduced blood supply, inadequate
nutrition, loss of endocrine stimulation, pressure.
■​ Signs: Reduced size of the organ or tissue on physical exam or imaging.
Microscopically, cells are smaller, with fewer organelles.
■​ Symptoms: Generally, loss of function of the affected organ (e.g., muscle
weakness in disuse atrophy). Often asymptomatic if mild or physiological.
○​ Hypertrophy:
■​ Definition: An increase in the size of individual cells, leading to an increase
in the size of the organ or tissue, without an increase in cell number.
■​ Causes: Increased workload (e.g., exercise, hypertension), hormonal
stimulation.
■​ Signs: Increased organ size on physical exam or imaging. Microscopically,
cells are noticeably larger, often with enlarged nuclei and increased
organelles.
■​ Symptoms: May be asymptomatic. Symptoms relate to the consequences of
hypertrophy (e.g., shortness of breath in cardiac hypertrophy).
○​ Hyperplasia:
■​ Definition: An increase in the number of cells in an organ or tissue, leading
to an increase in its size.
■​ Causes: Physiological (hormonal stimulation, compensatory growth) or
pathological (excessive hormonal/growth factor stimulation, chronic irritation).
■​ Signs: Enlarged organ or tissue on physical exam or imaging.
Microscopically, an increased number of morphologically normal cells, often
organized.
■​ Symptoms: Depend on the affected organ (e.g., abnormal uterine bleeding
in endometrial hyperplasia, urinary symptoms in benign prostatic
hyperplasia).
○​ Metaplasia:
■​ Definition: A reversible change in which one adult differentiated cell type is
replaced by another adult differentiated cell type, usually as an adaptive
response to chronic irritation.
■​ Causes: Chronic irritation or inflammation (e.g., smoking, acid reflux, chronic
infection).
■​ Signs: Microscopically, presence of an abnormal but mature cell type in a
location where it is not normally found. The new cell type may lose
specialized functions (e.g., cilia in respiratory metaplasia).
■​ Symptoms: Usually asymptomatic regarding the metaplasia itself, but
symptoms of the underlying chronic irritation or disease (e.g., smoker's
cough, heartburn).
○​ Dysplasia:
■​ Definition: "Disordered growth" characterized by abnormal changes in the
size, shape, and organization of adult cells in a tissue, considered a
pre-malignant condition.
■​ Causes: Persistent chronic irritation, inflammation, or genetic abnormalities.
Often arises in areas of metaplasia or hyperplasia.
■​ Signs: Only detectable microscopically. Cells show pleomorphism (variation
 in size/shape), anisokaryosis (variation in nuclear size), hyperchromatism
(dark nuclei), increased mitotic activity, and loss of polarity.
■​ Symptoms: Usually asymptomatic, detected by screening or incidental
biopsy. Symptoms are related to the underlying condition (e.g., abnormal
bleeding for cervical dysplasia).

10. Inflammation & Repair

(a) Acute Inflammation
●​ Definition: The immediate and early protective response of vascularized tissues to injury
or infection, characterized by rapid delivery of plasma proteins and leukocytes (primarily
neutrophils) to the site of injury.
●​ Causes (Etiology): Infections (bacteria, viruses), tissue necrosis, physical agents
(trauma, burns), chemical agents, foreign bodies, immune reactions.
●​ Signs:
○​ Local Cardinal Signs: Redness (rubor), heat (calor), swelling (tumor), pain (dolor),
and loss of function (functio laesa).
○​ Systemic Signs: Fever, leukocytosis (increased WBC count), increased
acute-phase proteins (e.g., C-reactive protein, ESR).
●​ Symptoms: Pain, loss of function. Systemic symptoms (if significant) include fever,
malaise, chills, and aches.
○​ Morphological Types:
■​ Serous Inflammation:
■​ Definition: Outpouring of thin, watery fluid (serous exudate).
■​ Causes: Mild injury, accumulation of fluid from plasma or mesothelial
cells.
■​ Signs: Skin blister from a burn, pleural effusion.
■​ Symptoms: Swelling, mild discomfort.
■​ Fibrinous Inflammation:
■​ Definition: Formation of a thick, sticky, yellowish meshwork of fibrin in
extravascular tissue.
■​ Causes: More severe injuries, typically affecting lining of body cavities
(e.g., pericarditis, pleuritis).
■​ Signs: Grossly, "bread-and-butter" appearance on serosal surfaces.
Microscopically, amorphous eosinophilic meshwork.
■​ Symptoms: Often localized pain depending on affected organ (e.g.,
pleuritic chest pain, pericardial pain).
■​ Purulent (Suppurative) Inflammation / Abscess Formation:
■​ Definition: Production of large amounts of pus (purulent exudate), a
creamy fluid of dead neutrophils, necrotic cells, and microbial debris.
An abscess is a localized collection of pus encapsulated within tissue.
■​ Causes: Pyogenic (pus-forming) bacterial infections (e.g.,
staphylococci, streptococci).
■​ Signs: Localized fluctuant swelling, erythema, warmth. If superficial,
may drain. Systemic signs of infection (fever, leukocytosis).
■​ Symptoms: Fever, localized pain, swelling, tenderness.
■​ Ulceration:
■​ Definition: A local excavation of a surface due to shedding of necrotic
 inflammatory tissue.
■​ Causes: Inflammatory necrosis of the surface (e.g., peptic ulcer,
decubitus ulcers, aphthous ulcers).
■​ Signs: Visible break in the continuity of a surface, often with an
inflamed base.
■​ Symptoms: Pain, bleeding, discomfort depending on location.
(b) Inflammatory Mediators
●​ Definition: Chemical substances produced by cells or derived from plasma proteins that
initiate, amplify, regulate, and terminate inflammatory responses.
●​ Causes (Etiology): Released or activated by inflammatory stimuli (e.g., microbes,
necrotic cells, immune reactions).
●​ Signs: The observable signs of inflammation (redness, heat, swelling, fever) are
manifestations of mediator actions.
●​ Symptoms: The subjective symptoms of inflammation (pain, malaise) are largely due to
these mediators.
(c) Chronic Inflammation
●​ Definition: A prolonged inflammatory response (weeks to months or years) characterized
by infiltration of mononuclear cells (macrophages, lymphocytes, plasma cells), tissue
destruction, and attempts at healing (fibrosis, angiogenesis).
●​ Causes (Etiology): Persistent infections (e.g., Mycobacterium tuberculosis, fungi),
hypersensitivity/autoimmune diseases, prolonged exposure to toxic agents, foreign body
reactions.
●​ Signs:
○​ Local: Persistent swelling, fibrosis, sometimes granulomas. Organ enlargement or
palpable masses.
○​ Systemic: Low-grade fever, weight loss, anemia, elevated ESR, CRP.
●​ Symptoms: Often insidious onset and prolonged course. Local symptoms include dull
pain, swelling, tenderness, loss of function. Systemic symptoms include fatigue,
low-grade fever, weight loss, and general malaise.
○​ Tuberculosis (as example):
■​ Definition: A chronic communicable disease caused by Mycobacterium
tuberculosis, typically affecting lungs but can affect any organ, characterized
by granulomatous inflammation.
■​ Causes: Infection with Mycobacterium tuberculosis (acid-fast bacillus),
primarily airborne transmission.
■​ Signs:
■​ Pulmonary TB: Abnormal breath sounds, dullness to percussion,
wasting.
■​ Systemic: Cachexia, pallor, palpable lymph nodes (in lymph node TB).
■​ Microscopically, characteristic granulomas with or without caseous
necrosis.
■​ Symptoms:
■​ Pulmonary TB: Chronic cough (often productive, sometimes bloody),
fever (low-grade, evening rise), night sweats, weight loss, fatigue, chest
pain.
■​ Extrapulmonary TB: Symptoms vary by affected organ (e.g.,
lymphadenopathy, joint pain, abdominal pain).
(d) Regeneration & Repair
 ●​ Definition:
○​ Regeneration: Complete replacement of damaged tissue by cells of the same type,
restoring normal structure and function.
○​ Repair (Healing by Scar Formation/Fibrosis): Replacement of damaged tissue
with connective tissue (fibrosis), forming a scar; provides structural integrity but
lacks original function.
●​ Causes (Etiology): Any injury that results in tissue damage. The type depends on tissue
type (labile, stable, permanent), severity of injury, presence of infection/chronic
inflammation, nutritional status, and systemic factors.
●​ Signs:
○​ Regeneration: Normal tissue appearance and function restored.
○​ Repair: Visible scar tissue (initially red and raised, then pale and flat), loss of
specialized structures (e.g., hair follicles in skin scar), reduced elasticity/strength.
●​ Symptoms:
○​ Regeneration: No specific symptoms as function is restored.
○​ Repair: Symptoms related to scar formation (e.g., stiffness in a joint scar, cosmetic
concerns, pain from nerve entrapment).

11. Haemodynamic Disorders

(a) Hyperaemia & Congestion
●​ Hyperaemia:
○​ Definition: An active process resulting from increased arterial inflow of blood into a
tissue.
○​ Causes: Arteriolar dilation (e.g., exercise, inflammation, blush).
○​ Signs: Tissue appears red (erythema) due to increased oxygenated blood.
○​ Symptoms: Increased warmth in the affected area (e.g., during exercise).
●​ Congestion:
○​ Definition: A passive process resulting from impaired venous outflow of blood from
a tissue.
○​ Causes: Obstruction to venous drainage (e.g., heart failure, local venous
compression, deep vein thrombosis).
○​ Signs: Tissue appears bluish-red (cyanotic) due to stagnant deoxygenated blood.
Organ may be enlarged and heavier.
○​ Symptoms: Often cause symptoms related to organ dysfunction (e.g., shortness of
breath in pulmonary congestion, swelling in peripheral congestion).
(b) Oedema (Edema)
●​ Definition: The accumulation of excessive fluid in the interstitial spaces within tissues or
in body cavities.
●​ Causes: Increased hydrostatic pressure (e.g., heart failure, venous obstruction),
decreased plasma oncotic pressure (e.g., hypoalbuminemia from liver/kidney disease,
malnutrition), lymphatic obstruction (e.g., filariasis, tumor), increased vascular
permeability (e.g., inflammation, allergic reactions).
●​ Signs: Swelling (pitting edema if fluid displaces on pressure), increased weight of
affected tissue/organ. Effusions in body cavities (e.g., pleural effusion, ascites).
●​ Symptoms: Swelling, tightness of skin, discomfort, difficulty wearing shoes/clothes. Can
cause shortness of breath if in lungs, or abdominal distension if ascites.
(c) Thrombosis & Embolism
 ●​ Thrombosis:
○​ Definition: The formation of a solid mass of blood constituents (a thrombus) within
the vascular system during life.
○​ Causes: Virchow’s Triad: Endothelial injury, stasis or turbulence of blood flow, and
hypercoagulability of blood.
○​ Signs: Localized swelling, warmth, pain (e.g., deep vein thrombosis). Can cause
signs of ischemia distal to the clot (e.g., pallor, coldness, diminished pulses).
○​ Symptoms: Pain, tenderness, swelling in the affected area.
●​ Embolism:
○​ Definition: The sudden occlusion of a blood vessel by an embolus (an
intravascular solid, liquid, or gaseous mass carried by blood to a distant site).
○​ Causes: Detachment of a thrombus (thromboembolism, most common), fat (e.g.,
bone fractures), air (e.g., diving, surgery), amniotic fluid, tumor fragments.
○​ Signs: Signs of sudden organ ischemia/infarction depending on location (e.g.,
sudden dyspnea and hypoxemia in pulmonary embolism, neurological deficits in
cerebral embolism).
○​ Symptoms: Sudden onset of severe pain, shortness of breath, or neurological
symptoms depending on the affected organ.
(d) Shock
●​ Definition: A life-threatening syndrome characterized by a generalized reduction in tissue
perfusion that is inadequate to meet the metabolic demands of the tissues, leading to
cellular hypoxia and organ dysfunction.
●​ Types & Causes:
○​ Hypovolemic: Severe hemorrhage, fluid loss (e.g., burns, severe
vomiting/diarrhea).
○​ Cardiogenic: Heart pump failure (e.g., myocardial infarction, severe arrhythmia,
severe valve disease).
○​ Septic: Systemic infection (bacterial toxins causing widespread vasodilation and
increased permeability).
○​ Anaphylactic: Severe systemic allergic reaction (IgE-mediated widespread
vasodilation and increased permeability).
○​ Neurogenic: Spinal cord injury, severe brain injury (loss of sympathetic tone).
●​ Signs: Hypotension (low blood pressure), tachycardia (rapid heart rate), tachypnea (rapid
breathing), pale/clammy skin (cold shock), warm/flushed skin (septic shock), weak pulses,
decreased urine output, altered mental status.
●​ Symptoms: Weakness, dizziness, confusion, cold/clammy feeling, thirst.

12. Diseases of Immune System

(a) Hypersensitivity Reactions
●​ Definition: Damaging immune responses to antigens that are otherwise harmless,
representing an excessive or inappropriate immune reaction leading to tissue injury and
disease.
●​ Types & Causes:
○​ Type I (Immediate/Anaphylactic):
■​ Definition: IgE-mediated, rapid onset reaction.
■​ Causes: Exposure to allergens (e.g., pollen, dust mites, food, insect venom,
drugs).
 ■​ Signs: Skin rash (urticaria), angioedema, bronchospasm, hypotension,
swelling.
■​ Symptoms: Itching, sneezing, wheezing, shortness of breath, abdominal
cramps, feeling of impending doom (anaphylaxis).
○​ Type II (Antibody-Mediated/Cytotoxic):
■​ Definition: IgG or IgM antibodies bind to antigens on cell surfaces, leading to
cell destruction or functional derangements.
■​ Causes: Transfusion reactions, autoimmune hemolytic anemia, Rh
incompatibility (hemolytic disease of newborn), some drug reactions,
Goodpasture syndrome, Myasthenia Gravis.
■​ Signs: Hemolysis (jaundice, anemia), tissue inflammation in specific organs
(e.g., kidney, thyroid).
■​ Symptoms: Fatigue, weakness, specific organ dysfunction symptoms (e.g.,
muscle weakness in Myasthenia Gravis).
○​ Type III (Immune Complex-Mediated):
■​ Definition: Formation of circulating antigen-antibody immune complexes that
deposit in tissues, leading to inflammation.
■​ Causes: Persistent infections (e.g., chronic viral hepatitis), autoimmune
diseases (e.g., Systemic Lupus Erythematosus), extrinsic antigens (e.g.,
serum sickness, Arthus reaction).
■​ Signs: Rash, arthritis, glomerulonephritis (signs of kidney damage like
edema, hypertension), vasculitis.
■​ Symptoms: Joint pain, skin rashes, fever, abdominal pain.
○​ Type IV (Cell-Mediated/Delayed-Type Hypersensitivity - DTH):
■​ Definition: T-cell mediated reaction, typically delayed (24-72 hours).
■​ Causes: Contact dermatitis (poison ivy, nickel), tuberculosis (TB test),
multiple sclerosis, type 1 diabetes.
■​ Signs: Redness, swelling, induration (hardening) at exposure site (e.g.,
contact dermatitis, positive tuberculin skin test).
■​ Symptoms: Itching, rash, blistering.
(b) Autoimmune Diseases
●​ Definition: Conditions where the immune system loses self-tolerance and mistakenly
attacks the body's own tissues, causing chronic inflammation and tissue damage.
●​ Causes: Complex interplay of genetic predisposition and environmental triggers
(infections, drugs, toxins) that break self-tolerance.
●​ Signs: Vary widely depending on the affected organs (e.g., joint deformities in rheumatoid
arthritis, malar rash in SLE, thyroid goiter in Hashimoto's).
●​ Symptoms: Highly variable and often systemic (e.g., fatigue, fever, weight loss, joint pain,
skin rashes, specific organ dysfunction symptoms).
(c) Immune Deficiency Disorders
●​ Definition: Conditions where the immune system's ability to protect the body is
compromised or absent, leading to increased susceptibility to infections and
malignancies.
●​ Types & Causes:
○​ Primary (Congenital): Genetic defects affecting immune cell development or
function (e.g., Severe Combined Immunodeficiency (SCID), DiGeorge syndrome,
X-linked agammaglobulinemia).
○​ Secondary (Acquired): Caused by external factors (e.g., HIV/AIDS, chemotherapy,
 radiation, malnutrition, chronic diseases like diabetes or kidney failure,
immunosuppressive drugs).
●​ Signs: Recurrent or unusual infections (especially opportunistic infections), poor growth
in children, signs of specific organ infections.
●​ Symptoms: Frequent or prolonged infections, unusual infections, poor healing, chronic
diarrhea, unexplained weight loss.

Amrāz A'zā' Tabī'iyya - I (Diseases of Natural Organs - I)

(a) Qula', Waram Mi'da, Zu'f Hazm, Zu'f Ishtihā', Zahir, Husr (Qabz), Bawāsīr
●​ Qula' (Aphthous Ulcers/Mouth Sores):
○​ Definition: Painful sores or ulcers on the mucous membranes of the mouth.
○​ Causes: Often idiopathic, but can be triggered by stress, trauma, certain foods,
nutritional deficiencies (e.g., B12, folate, iron), or systemic diseases.
○​ Signs: Small, round/oval ulcers with a white/yellow center and red border, usually
on non-keratinized surfaces.
○​ Symptoms: Pain, discomfort, especially when eating or speaking.
●​ Waram Mi'da (Gastritis):
○​ Definition: Inflammation of the stomach lining.
○​ Causes: Helicobacter pylori infection, NSAIDs, alcohol, stress, autoimmune
reactions, bile reflux.
○​ Signs: May include epigastric tenderness, signs of bleeding if severe.
○​ Symptoms: Upper abdominal pain, nausea, vomiting, bloating, loss of appetite.
●​ Zu'f Hazm (Indigestion/Dyspepsia):
○​ Definition: A collection of symptoms related to impaired digestion.
○​ Causes: Functional (no identifiable cause), GERD, peptic ulcer disease, gallstones,
pancreatitis, irritable bowel syndrome, certain foods/habits.
○​ Signs: Non-specific, may include abdominal distension.
○​ Symptoms: Bloating, nausea, heartburn, discomfort after eating, early satiety.
●​ Zu'f Ishtihā' (Loss of Appetite/Anorexia):
○​ Definition: Diminished or absent desire to eat.
○​ Causes: Acute/chronic illness, infections, psychological factors (depression,
anxiety, anorexia nervosa), medications, pain, gastrointestinal disorders.
○​ Signs: Weight loss, signs of nutritional deficiency if prolonged.
○​ Symptoms: Lack of hunger, aversion to food.
●​ Zahir (Diarrhea/Loose Motions):
○​ Definition: Frequent passage of loose, watery stools.
○​ Causes: Infections (bacterial, viral, parasitic), food poisoning, inflammatory bowel
disease, irritable bowel syndrome, malabsorption syndromes, medications.
○​ Signs: Increased frequency and liquidity of stools, signs of dehydration (dry
mucous membranes, reduced skin turgor).
○​ Symptoms: Abdominal cramps, urgent need to defecate, nausea, fatigue.
●​ Husr (Qabz) (Constipation):
○​ Definition: Infrequent or difficult bowel movements.
○​ Causes: Low fiber intake, dehydration, lack of physical activity, certain medications,
irritable bowel syndrome, structural abnormalities, neurological conditions,
endocrine disorders.
○​ Signs: Hard, dry stools. Abdominal distension, tenderness.
 ○​ Symptoms: Straining during bowel movements, feeling of incomplete evacuation,
abdominal discomfort.
●​ Bawāsīr (Hemorrhoids/Piles):
○​ Definition: Swollen veins in the lower rectum and anus.
○​ Causes: Straining during bowel movements, chronic constipation, pregnancy,
obesity, prolonged sitting.
○​ Signs: External hemorrhoids are palpable lumps. Internal hemorrhoids may
prolapse. Bleeding (bright red blood with stool).
○​ Symptoms: Pain, itching, discomfort, bleeding during defecation.
(b) Gastritis, Peptic Ulcer Disease, Enteric Fever, Dysentery, Inflammatory Bowel Disease
●​ Gastritis: (See Waram Mi'da above)
●​ Peptic Ulcer Disease:
○​ Definition: Open sores in the lining of the stomach, duodenum, or esophagus.
○​ Causes: Helicobacter pylori infection, NSAID use, Zollinger-Ellison syndrome
(rare).
○​ Signs: Epigastric tenderness. Signs of bleeding (melena, hematemesis).
Perforation can lead to peritonitis.
○​ Symptoms: Burning epigastric pain (often relieved by food/antacids, recurs hours
after eating), bloating, nausea, heartburn.
●​ Enteric Fever (Typhoid Fever):
○​ Definition: A systemic infection caused by Salmonella Typhi bacteria.
○​ Causes: Ingestion of food or water contaminated with Salmonella Typhi bacteria.
○​ Signs: Sustained high fever ("step-ladder" pattern), relative bradycardia, rose spots
(rash on trunk), splenomegaly.
○​ Symptoms: Sustained fever, headache, malaise, abdominal pain, constipation or
pea-soup diarrhea, fatigue.
●​ Dysentery:
○​ Definition: An infection of the intestines causing bloody diarrhea, fever, and
abdominal cramps.
○​ Causes: Bacterial (e.g., Shigella, enteroinvasive E. coli) or amoebic (e.g.,
Entamoeba histolytica).
○​ Signs: Frequent, small volume stools containing blood and mucus. Fever.
Dehydration.
○​ Symptoms: Abdominal cramps, tenesmus (feeling of incomplete defecation),
bloody diarrhea, fever.
●​ Inflammatory Bowel Disease (IBD):
○​ Definition: Chronic inflammatory conditions affecting the gastrointestinal tract
(Crohn's disease and Ulcerative Colitis).
○​ Causes: Unknown, but involves genetic predisposition, immune system
dysfunction, and environmental factors.
○​ Signs: Weight loss, signs of malnutrition, abdominal tenderness, anemia.
Extraintestinal manifestations (e.g., joint pain, skin lesions, eye inflammation).
○​ Symptoms: Chronic abdominal pain, diarrhea (often bloody in UC), weight loss,
fatigue, fever, rectal bleeding (UC).

15. Amrāz A'zā' Tabī'iyya - II (Diseases of Liver, Gallbladder &

Pancreas)
(a) Zu'f Kabid, Waram Kabid, Yarqān
●​ Zu'f Kabid (Hepatic Insufficiency/Weakness of Liver):
○​ Definition: Impaired liver function.
○​ Causes: Chronic liver diseases (e.g., chronic hepatitis, cirrhosis), severe acute
hepatitis, toxins, prolonged malnutrition.
○​ Signs: Non-specific, may include mild jaundice, fatigue.
○​ Symptoms: Fatigue, malaise, poor digestion, general weakness.
●​ Waram Kabid (Hepatitis):
○​ Definition: Inflammation of the liver.
○​ Causes: Viral infections (Hepatitis A, B, C, D, E), alcohol, drugs, autoimmune
diseases, metabolic disorders.
○​ Signs: Jaundice, hepatomegaly (enlarged liver), dark urine, pale stools, spider
angiomas (chronic).
○​ Symptoms: Fatigue, nausea, vomiting, loss of appetite, right upper quadrant pain,
fever, malaise.
●​ Yarqān (Jaundice):
○​ Definition: Yellowing of the skin, sclera (whites of eyes), and mucous membranes
due to high bilirubin levels.
○​ Causes: Pre-hepatic (excessive RBC breakdown, e.g., hemolytic anemia), hepatic
(liver disease, e.g., hepatitis, cirrhosis), or post-hepatic (bile duct obstruction, e.g.,
gallstones, pancreatic tumor).
○​ Signs: Yellow discoloration of skin and sclera. Dark urine, pale stools. Pruritus
(itching).
○​ Symptoms: Often a sign, not a symptom itself, but patients may notice yellowing.
May be accompanied by fatigue and malaise.
(b) Viral Hepatitis, Jaundice, Cirrhosis of Liver, Cholecystitis, Pancreatitis, Diabetes
Mellitus
●​ Viral Hepatitis:
○​ Definition: Inflammation of the liver caused by specific viruses (e.g., Hepatitis A, B,
C, D, E).
○​ Causes: Infection with Hepatitis A, B, C, D, or E viruses.
○​ Signs: Jaundice, hepatomegaly, splenomegaly, dark urine, pale stools, signs of
chronic liver disease if it progresses.
○​ Symptoms: Fatigue, fever, nausea, vomiting, loss of appetite, right upper quadrant
pain, joint pain.
●​ Jaundice: (See Yarqān above)
●​ Cirrhosis of Liver:
○​ Definition: A late stage of chronic liver disease where healthy liver tissue is
replaced by scar tissue (fibrosis), leading to irreversible liver damage.
○​ Causes: Chronic viral hepatitis (B & C), chronic alcohol abuse, non-alcoholic fatty
liver disease (NAFLD/NASH), autoimmune hepatitis, hereditary hemochromatosis,
Wilson's disease, primary biliary cholangitis.
○​ Signs: Jaundice, ascites (abdominal fluid), peripheral edema, spider angiomas,
palmar erythema, caput medusae, splenomegaly, hepatic encephalopathy
(confusion), asterixis (flapping tremor).
 ○​ Symptoms: Fatigue, weakness, nausea, loss of appetite, weight loss, abdominal
swelling, leg swelling, easy bruising/bleeding, confusion.
●​ Cholecystitis:
○​ Definition: Inflammation of the gallbladder.
○​ Causes: Most commonly gallstones obstructing the cystic duct, leading to bile
stasis and inflammation. Less commonly, acalculous cholecystitis.
○​ Signs: Right upper quadrant tenderness (Murphy's sign), fever, guarding, jaundice
if bile duct is obstructed.
○​ Symptoms: Severe upper abdominal pain (often after fatty meals), radiating to right
shoulder, nausea, vomiting, fever.
●​ Pancreatitis:
○​ Definition: Inflammation of the pancreas.
○​ Causes: Gallstones, alcohol abuse, hypertriglyceridemia, abdominal trauma,
certain medications, autoimmune diseases.
○​ Signs: Severe upper abdominal tenderness, abdominal distension, fever,
tachycardia. In severe cases, Cullen's sign (periumbilical ecchymosis) or
Grey-Turner's sign (flank ecchymosis).
○​ Symptoms: Severe upper abdominal pain radiating to the back, nausea, vomiting,
fever, rapid pulse, indigestion.
●​ Diabetes Mellitus:
○​ Definition: A group of metabolic disorders characterized by high blood sugar levels
over a prolonged period, due to insufficient insulin production or ineffective insulin
action.
○​ Causes:
■​ Type 1: Autoimmune destruction of pancreatic beta cells (genetic
predisposition, environmental triggers).
■​ Type 2: Insulin resistance and progressive beta cell dysfunction (obesity,
sedentary lifestyle, genetics).
■​ Gestational: Insulin resistance during pregnancy.
■​ Other: Pancreatic diseases, certain medications.
○​ Signs: Polydipsia (excessive thirst), polyuria (frequent urination), polyphagia
(increased hunger), unexplained weight loss, blurred vision, slow-healing sores,
recurrent infections.
○​ Symptoms: Excessive thirst, frequent urination, increased hunger, fatigue, blurred
vision, numbness/tingling in hands/feet.

16. Amrāz Kulya & Masāna (Diseases of Kidney & Bladder)

(a) Zu'f Kulya, Zayābītus, Hasāt Kulya & Masāna, Waram Masāna, Taqtirul Bawl
●​ Zu'f Kulya (Kidney Insufficiency/Renal Weakness):
○​ Definition: Impaired kidney function, leading to reduced ability to filter waste from
blood.
○​ Causes: Acute kidney injury (e.g., severe dehydration, shock, drug toxicity) or
chronic kidney disease (e.g., diabetes, hypertension, glomerulonephritis, polycystic
kidney disease).
○​ Signs: Edema (swelling, especially in legs/face), pallor, hypertension, signs of
electrolyte imbalance.
○​ Symptoms: Fatigue, weakness, reduced urine output, swelling, loss of appetite,
 nausea, itching.
●​ Zayābītus (Diabetes Mellitus, and sometimes Diabetes Insipidus): (Focusing on
Diabetes Mellitus as most common usage in Unani context and relevance to kidney
complications).
○​ Definition: See Diabetes Mellitus definition above in section 15(b).
○​ Causes: (Same as Diabetes Mellitus) Type 1 (autoimmune), Type 2 (insulin
resistance, beta cell dysfunction).
○​ Signs: (Same as Diabetes Mellitus) Polydipsia, polyuria, polyphagia, blurred vision,
signs of neuropathy or nephropathy (e.g., edema).
○​ Symptoms: (Same as Diabetes Mellitus) Excessive thirst, frequent urination,
increased hunger, fatigue, blurred vision, numbness/tingling.
●​ Hasāt Kulya & Masāna (Kidney Stones & Bladder Stones/Urolithiasis):
○​ Definition: Hard deposits made of minerals and salts that form inside the kidneys
or bladder.
○​ Causes: Dehydration, high intake of certain foods (e.g., high oxalate foods), family
history, certain metabolic conditions (e.g., hyperparathyroidism), urinary tract
infections, gout.
○​ Signs: Hematuria (blood in urine, visible or microscopic), tenderness in flank or
lower abdomen, fever if infection.
○​ Symptoms: Severe, sharp pain in the back and side (renal colic) that may radiate
to the lower abdomen/groin, pain on urination, nausea, vomiting, urge to urinate.
●​ Waram Masāna (Cystitis/Inflammation of the Bladder):
○​ Definition: Inflammation of the bladder, often due to bacterial infection (UTI).
○​ Causes: Bacterial infections (most commonly E. coli), irritation from certain
chemicals or hygiene products, catheters.
○​ Signs: Suprapubic tenderness, fever (if severe), abnormal urinalysis (pyuria,
bacteriuria).
○​ Symptoms: Painful urination (dysuria), frequent urination, urgency, lower
abdominal discomfort, cloudy/foul-smelling urine.
●​ Taqtirul Bawl (Frequent Micturition/Urinary Frequency):
○​ Definition: Abnormally frequent urination, often with dribbling or difficulty initiating
flow.
○​ Causes: Urinary tract infection, enlarged prostate (BPH), overactive bladder,
diabetes (mellitus or insipidus), diuretics, anxiety.
○​ Signs: Increased voiding frequency, small urine volumes per void, signs of
underlying cause (e.g., enlarged prostate on DRE).
○​ Symptoms: Constant urge to urinate, passing small amounts frequently, feeling of
incomplete emptying, discomfort.
(b) Renal Failure, Glomerulonephritis, Nephritic & Nephrotic Syndrome, Urolithiasis
●​ Renal Failure:
○​ Definition: Condition where kidneys lose ability to adequately remove waste
products and maintain fluid/electrolyte balance.
○​ Causes: Acute kidney injury (e.g., severe dehydration, shock, drug toxicity) or
chronic kidney disease (e.g., diabetes, hypertension, glomerulonephritis, polycystic
kidney disease).
○​ Signs: Edema, hypertension, pallor, signs of uremia (e.g., uremic frost, pericardial
rub, neurological changes), abnormal lab tests (elevated creatinine, BUN).
○​ Symptoms: Fatigue, weakness, nausea, loss of appetite, swelling, reduced urine
 output, itching, muscle cramps.
●​ Glomerulonephritis:
○​ Definition: Inflammation of the glomeruli, the kidney's filtering units.
○​ Causes: Post-streptococcal infection, autoimmune diseases (e.g., lupus, IgA
nephropathy), vasculitis, certain infections (e.g., endocarditis).
○​ Signs: Hematuria (cola-colored urine), proteinuria, hypertension, edema, signs of
kidney failure.
○​ Symptoms: Swelling (especially face/eyes), reduced urine output, dark urine,
shortness of breath, fatigue.
●​ Nephritic Syndrome:
○​ Definition: Clinical syndrome characterized by glomerular inflammation, leading to
hematuria (often microscopic), proteinuria (<3.5g/day), hypertension, and mild
edema.
○​ Causes: Post-infectious glomerulonephritis, IgA nephropathy, rapidly progressive
glomerulonephritis, lupus nephritis.
○​ Signs: Hematuria (red or smoky urine), hypertension, mild edema
(facial/periorbital), oliguria.
○​ Symptoms: Sudden onset of swelling, dark urine, fatigue, shortness of breath.
●​ Nephrotic Syndrome:
○​ Definition: Kidney disorder characterized by significant protein loss in urine
(>3.5g/day), leading to low blood protein, severe edema, high cholesterol, and lipids
in urine.
○​ Causes: Primary glomerular diseases (e.g., minimal change disease, focal
segmental glomerulosclerosis, membranous nephropathy) or secondary causes
(e.g., diabetes mellitus, amyloidosis, lupus, certain drugs).
○​ Signs: Severe, generalized edema (anasarca), ascites, pleural effusions,
hyperlipidemia, frothy urine.
○​ Symptoms: Pronounced swelling (face, ankles, abdomen), weight gain due to fluid,
fatigue, loss of appetite.
●​ Urolithiasis: (See Hasāt Kulya & Masāna above)

17. Amrāz A'zā' Tanāṣul (Diseases of Reproductive Organs)

●​ Zu'f Bāh (Sexual Debility/Erectile Dysfunction):
○​ Definition: Inability to achieve or maintain an erection sufficient for satisfactory
sexual performance.
○​ Causes: Cardiovascular disease (atherosclerosis), diabetes, hypertension,
neurological disorders, hormonal imbalances (low testosterone), psychological
factors (stress, anxiety, depression), medications, alcohol/smoking.
○​ Signs: No specific physical signs of the condition itself, but may have signs of
underlying causes (e.g., diabetes, cardiovascular disease).
○​ Symptoms: Difficulty achieving or maintaining an erection, reduced sexual desire.
●​ Jarayān (Nocturnal Emission/Spermatorrhea):
○​ Definition: Involuntary discharge of seminal fluid without sexual activity or orgasm.
○​ Causes: Often a normal physiological event, particularly during adolescence. Can
be exacerbated by anxiety, stress, or certain medications.
○​ Signs: No specific physical signs.
○​ Symptoms: Awareness of semen discharge, sometimes accompanied by
 weakness or guilt.
●​ 'Uqr (Infertility):
○​ Definition: Inability to conceive after a certain period (typically 12 months) of
unprotected intercourse.
○​ Causes:
■​ Female: Ovulatory disorders (e.g., PCOS), fallopian tube damage (e.g., PID),
endometriosis, uterine/cervical factors.
■​ Male: Low sperm count/motility/morphology, varicocele, obstruction of sperm
ducts, hormonal imbalances.
■​ Unexplained: No identifiable cause.
○​ Signs: No specific general signs. May have signs of underlying causes (e.g.,
hormonal imbalances, structural abnormalities).
○​ Symptoms: Inability to achieve pregnancy.
●​ Sayalānur Rahim (Leukorrhea/Vaginal Discharge):
○​ Definition: A white or yellowish discharge from the vagina.
○​ Causes: Normal physiological changes, infections (e.g., bacterial vaginosis,
candidiasis, trichomoniasis, STIs), inflammation, foreign bodies, hormonal changes.
○​ Signs: Visible vaginal discharge (color, consistency, odor varies with cause), vulvar
irritation/redness.
○​ Symptoms: Vaginal discharge, itching, burning, discomfort, foul odor.

18. Amrāz A'zā' Haywānīya - I: Amrāz Qalb & 'Urūq (Diseases of Heart
& Blood Vessels)
(a) Khafaqān, Ghashī
●​ Khafaqān (Palpitations):
○​ Definition: A subjective sensation of an abnormal or irregular heartbeat.
○​ Causes: Arrhythmias (e.g., atrial fibrillation, premature beats), structural heart
disease, anxiety/stress, caffeine, nicotine, alcohol, certain medications,
hyperthyroidism, anemia, fever.
○​ Signs: May have tachycardia or irregular pulse during episodes.
○​ Symptoms: Awareness of heart beating unusually, pounding, fluttering, racing, or
skipped beats.
●​ Ghashī (Syncope/Fainting):
○​ Definition: A sudden, brief loss of consciousness and postural tone, followed by
spontaneous recovery, caused by temporary insufficient blood flow to the brain.
○​ Causes: Cardiac (arrhythmias, structural heart disease), vascular/orthostatic
(orthostatic hypotension, vasovagal syncope), neurological (seizures, TIA),
hypoglycemia, hyperventilation.
○​ Signs: Pallor, clammy skin, weak pulse during episode, loss of consciousness,
collapse. Rapid recovery.
○​ Symptoms: Feeling lightheaded, dizzy, nauseous, tunnel vision before losing
consciousness.
(b) Ischaemic Heart Disease (Angina Pectoris & Myocardial Infarction), Endocarditis,
Rheumatic Heart Disease, Valvular Heart Disease (Mitral & Aortic Stenosis &
Regurgitation), Heart Failure, Pericarditis
●​ Ischaemic Heart Disease (IHD):
 ○​ Definition: Syndromes caused by an imbalance between the heart's oxygen supply
and demand, usually due to reduced blood flow in coronary arteries.
○​ Causes: Atherosclerosis of the coronary arteries (most common), less commonly
coronary artery spasm, vasculitis.
○​ Symptoms: Often asymptomatic until severe. Manifests as angina or myocardial
infarction.
○​ Signs: Signs of specific manifestations (see below).
○​ Angina Pectoris:
■​ Definition: Recurrent episodes of transient chest pain or discomfort caused
by temporary myocardial ischemia without cell death.
■​ Causes: Coronary artery atherosclerosis leading to significant narrowing,
triggered by increased myocardial oxygen demand (e.g., exertion, emotional
stress).
■​ Signs: Often none at rest. ECG may show transient ST depression during
attacks.
■​ Symptoms: Squeezing, pressure, heaviness in the chest, often radiating to
left arm/jaw/back, triggered by exertion/stress, relieved by rest/nitroglycerin.
○​ Myocardial Infarction (MI) / Heart Attack:
■​ Definition: Myocardial necrosis (heart muscle cell death) from prolonged
ischemia.
■​ Causes: Usually acute thrombosis superimposed on an atherosclerotic
plaque in a coronary artery, leading to complete occlusion.
■​ Signs: Patient appears distressed, pale, clammy. May have arrhythmias,
heart sounds (S3, S4), signs of heart failure. ECG changes are characteristic.
■​ Symptoms: Severe, prolonged chest pain (>20 min), not relieved by
rest/nitroglycerin, with shortness of breath, nausea, sweating.
●​ Endocarditis:
○​ Definition: Inflammation of the endocardium, primarily heart valves.
○​ Causes: Primarily bacterial (e.g., Staphylococcus aureus, streptococci), less
commonly fungal. Risk factors include pre-existing valve abnormalities, prosthetic
valves, IV drug use, poor dental hygiene.
○​ Signs: Fever, new or changing heart murmur, splinter hemorrhages, Osler's nodes,
Janeway lesions, Roth spots, signs of heart failure or systemic emboli.
○​ Symptoms: Persistent fever, chills, fatigue, shortness of breath, generalized aches,
weight loss.
●​ Rheumatic Heart Disease (RHD):
○​ Definition: Chronic heart condition resulting from autoimmune reaction to prior
Group A Strep throat infection, primarily damaging heart valves.
○​ Causes: Untreated or inadequately treated Group A Streptococcal pharyngitis
(strep throat).
○​ Signs: Specific heart murmurs depending on affected valve, signs of heart failure,
arrhythmias. (Acute stage: Fever, inflamed joints, new heart murmur).
○​ Symptoms: Often asymptomatic for years, then symptoms of valvular heart
disease (shortness of breath, fatigue, chest pain, syncope) or heart failure. (Acute
stage: Fever, migratory polyarthritis, carditis, chorea).
●​ Valvular Heart Disease (Mitral & Aortic Stenosis & Regurgitation):
○​ Definition: Conditions where heart valves are narrowed (stenosis) obstructing
blood flow, or leaky (regurgitation) allowing backward flow.
 ○​ Causes: Degenerative changes (calcification, age-related), rheumatic heart
disease (most common global cause), congenital abnormalities, endocarditis,
ischemic heart disease.
○​ Signs: Distinctive heart murmurs on auscultation, abnormal heart sounds, signs of
heart failure.
○​ Symptoms: Vary by valve and severity. Common: shortness of breath (especially
on exertion), fatigue, chest pain, palpitations, dizziness/syncope.
●​ Heart Failure (HF):
○​ Definition: Clinical syndrome where the heart cannot pump sufficient blood to meet
tissue demands, or only at high filling pressures.
○​ Causes: Any condition that damages the heart or increases its workload: Ischemic
heart disease (most common), hypertension, valvular heart disease,
cardiomyopathies, arrhythmias, diabetes.
○​ Signs:
■​ Left-sided HF: Tachypnea, crackles/rales on lung auscultation, S3 gallop.
■​ Right-sided HF: Jugular venous distention (JVD), pitting peripheral edema,
hepatomegaly, ascites.
■​ General: Tachycardia, pallor, weakness.
○​ Symptoms:
■​ Left-sided HF: Dyspnea (on exertion, orthopnea, paroxysmal nocturnal
dyspnea), cough (frothy sputum).
■​ Right-sided HF: Peripheral edema, abdominal swelling, fatigue, anorexia.
●​ Pericarditis:
○​ Definition: Inflammation of the pericardium (sac around the heart).
○​ Causes: Viral infections (most common), bacterial, fungal, TB, autoimmune
diseases (SLE), post-cardiac injury (post-MI), uremia, idiopathic.
○​ Signs: Pericardial friction rub (scratching sound on auscultation), tachycardia. If
effusion, distant heart sounds. Pulsus paradoxus in tamponade.
○​ Symptoms: Sharp, stabbing chest pain (worsens with deep breathing/lying flat,
relieved by leaning forward), fever, malaise.
(c) Arteriosclerosis, Aneurysm, Hypertension
●​ Arteriosclerosis:
○​ Definition: General term for "hardening of the arteries" due to arterial wall
thickening and hardening.
○​ Types & Causes:
■​ Atherosclerosis: Formation of fibrofatty plaques (atheromas) in the intima of
large/medium arteries. Causes: Hyperlipidemia, hypertension, cigarette
smoking, diabetes mellitus, obesity, genetics.
■​ Mönckeberg Medial Sclerosis: Calcification of muscular arteries; cause
unknown, age-related.
■​ Arteriolosclerosis: Affects small arteries/arterioles. Causes: Hypertension,
diabetes.
○​ Signs: Depend on type and affected arteries (e.g., bruits over narrowed arteries,
diminished pulses).
○​ Symptoms: Often asymptomatic until complications arise (e.g., angina, stroke
symptoms, leg pain).
●​ Aneurysm:
○​ Definition: A localized, permanent abnormal dilation of a blood vessel or heart wall.
 ○​ Causes: Weakening of the vessel wall due to atherosclerosis (most common for
aortic), hypertension, genetic disorders (Marfan, Ehlers-Danlos), infections
(mycotic), trauma, vasculitis.
○​ Signs: Palpable pulsatile mass (abdominal aortic aneurysm), widened mediastinum
on chest X-ray (thoracic aortic aneurysm). Signs of rupture include hypotension and
shock.
○​ Symptoms: Often asymptomatic until rupture or compression of adjacent
structures. May include back pain, abdominal pain, chest pain, dysphagia. Rupture
causes sudden, severe pain.
●​ Hypertension (High Blood Pressure):
○​ Definition: A chronic medical condition characterized by persistently elevated
blood pressure in the arteries (systolic \ge 130 mmHg or diastolic \ge 80 mmHg).
○​ Causes:
■​ Primary (Essential): No identifiable cause (multifactorial: genetics, high salt,
obesity, lack of exercise, alcohol, stress).
■​ Secondary: Identifiable cause (e.g., kidney disease, endocrine disorders,
obstructive sleep apnea, certain medications).
○​ Signs: Elevated blood pressure readings (primary sign). Signs of end-organ
damage: retinopathy, left ventricular hypertrophy, proteinuria.
○​ Symptoms: Often asymptomatic ("silent killer"). Severe hypertension may cause
headache, dizziness, blurred vision, nosebleeds, shortness of breath. Long-term
complications lead to symptoms of target organ damage.

19. Amrāz A'zā' Haywānīya - II: Amrāz Ri'a (Diseases of Respiratory

Organs)
(a) Nazla & Zukām, Waram Halq, Zīqun Nafas, Su'āl, Zātul Ri'a
●​ Nazla & Zukām (Common Cold & Catarrh/Coryza):
○​ Definition: Acute, highly contagious viral infections of the upper respiratory tract.
○​ Causes: Primarily rhinoviruses, but also coronaviruses, adenoviruses, RSV.
○​ Signs: Runny nose (clear to thick), nasal congestion, inflamed throat.
○​ Symptoms: Runny nose, nasal congestion, sneezing, sore throat, cough, mild
headache, malaise, low-grade fever.
●​ Waram Halq (Pharyngitis/Sore Throat):
○​ Definition: Inflammation of the pharynx (throat).
○​ Causes: Most commonly viral (common cold viruses, influenza), bacterial
(Streptococcus pyogenes).
○​ Signs: Red, swollen throat, sometimes with exudates on tonsils, swollen neck
lymph nodes.
○​ Symptoms: Throat pain (especially on swallowing), scratchy throat, fever,
headache.
●​ Zīqun Nafas (Dyspnea/Shortness of Breath):
○​ Definition: A subjective sensation of uncomfortable breathing or "air hunger".
○​ Causes: Respiratory (asthma, COPD, pneumonia, PE, pneumothorax), cardiac
(heart failure, MI), anemia, metabolic acidosis, anxiety.
○​ Signs: Increased respiratory rate (tachypnea), use of accessory breathing muscles,
nasal flaring, cyanosis, wheezing, crackles on auscultation.
 ○​ Symptoms: Difficulty breathing, gasping for air, tightness in chest.
●​ Su'āl (Cough):
○​ Definition: A sudden, forceful exhalation to clear air passages of irritants or
secretions.
○​ Causes: Common cold, influenza, bronchitis, pneumonia, asthma, COPD, allergies,
post-nasal drip, GERD, certain medications (ACE inhibitors), irritants.
○​ Signs: Audible cough, sputum production (color, consistency), can lead to
hoarseness or chest pain.
○​ Symptoms: The act of coughing itself, can be dry or productive.
●​ Zātul Ri'a (Pneumonia):
○​ Definition: Acute inflammation of the lung parenchyma (alveoli and bronchioles)
caused by infectious agents.
○​ Causes: Bacteria (Streptococcus pneumoniae, Haemophilus influenzae,
Mycoplasma pneumoniae), viruses (influenza, RSV), fungi, aspiration.
○​ Signs: Tachypnea, crackles/rales on lung auscultation, dullness to percussion,
increased tactile fremitus, hypoxemia.
○​ Symptoms: Fever, chills, productive cough (sputum may be green, yellow, rusty, or
bloody), shortness of breath, chest pain, fatigue.
(b) Chronic Bronchitis, Emphysema, Bronchial Asthma, Bronchiectasis, Pneumonia
●​ Chronic Bronchitis:
○​ Definition: Clinical diagnosis of chronic productive cough for at least 3 months in 2
consecutive years, in absence of other causes; type of COPD.
○​ Causes: Predominantly long-term exposure to inhaled irritants, most commonly
cigarette smoke. Air pollution, occupational dusts.
○​ Signs: Chronic cough, rhonchi on auscultation, sometimes wheezing. Patients may
be cyanotic, overweight ("blue bloaters").
○​ Symptoms: Persistent productive cough with mucus, progressive shortness of
breath, frequent respiratory infections.
●​ Emphysema:
○​ Definition: Pathological diagnosis of permanent enlargement of airspaces distal to
terminal bronchioles with destruction of walls, without obvious fibrosis; type of
COPD.
○​ Causes: Predominantly cigarette smoking (leading to protease-antiprotease
imbalance). Alpha-1 antitrypsin deficiency (genetic predisposition) is a rare cause.
○​ Signs: Barrel chest, pursed-lip breathing, prolonged expiration, diminished breath
sounds. Patients are often thin ("pink puffers").
○​ Symptoms: Progressive shortness of breath (dyspnea) that worsens over time,
minimal cough (often dry), weight loss.
●​ Bronchial Asthma:
○​ Definition: Chronic inflammatory disease of the airways characterized by recurrent
episodes of reversible airway obstruction, bronchial hyperresponsiveness, and
inflammation.
○​ Causes: Complex interaction of genetic predisposition and environmental factors:
allergens (pollen, dust mites), irritants (smoke, pollution, cold air), exercise, viral
infections, stress, certain medications.
○​ Signs: Wheezing on auscultation (expiratory, inspiratory if severe), tachypnea, use
of accessory muscles, prolonged expiration.
○​ Symptoms: Episodic shortness of breath, wheezing, chest tightness, cough
 (especially at night or early morning).
●​ Bronchiectasis:
○​ Definition: Permanent and irreversible dilation of the bronchi and bronchioles,
caused by destruction of muscle and elastic tissue due to chronic necrotizing
infections.
○​ Causes: Severe or recurrent lung infections (e.g., TB, severe pneumonia,
measles), impaired mucociliary clearance (e.g., cystic fibrosis, primary ciliary
dyskinesia), airway obstruction (foreign body, tumor), immunodeficiency.
○​ Signs: Persistent crackles at lung bases, clubbing of fingers, weight loss.
○​ Symptoms: Chronic productive cough with large amounts of foul-smelling, purulent
sputum, recurrent respiratory infections, hemoptysis, shortness of breath, fatigue.
●​ Pneumonia: (See Zātul Ri'a above)