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Besson J, Brissot H, Azoulay F, Benzimra P, Fritz J. Spontaneous cecal perforation in a cat diagnosed with ultrasonography. Vet Radiol Ultrasound 2024; 65:275-278. [PMID: 38459956 DOI: 10.1111/vru.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
An 8-year-old cat was presented for an acute history of anorexia, marked abdominal pain, and hyperthermia. Ultrasonography showed a cecal perforation with focal steatitis and adjacent free gas bubbles, consistent with focal peritonitis. Surgery confirmed the imaging findings. An enterectomy was performed with the removal of the cecum and ileocolic valve, and anastomosis between the ileum and colon was performed. Histology revealed transmural enteritis and chronic severe pyogranulomatous peritonitis with intralesional plant fragments.
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Affiliation(s)
- Julie Besson
- Department of Imaging, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
| | - Hervé Brissot
- Department of Soft Tissue Surgery, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
| | - Florian Azoulay
- Department of Imaging, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
| | | | - Julien Fritz
- Department of Imaging, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
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2
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Angelou V, Fiska A, Tsingotjidou A, Patsikas M, Papazoglou LG. Surgical Anatomy of the Gastrointestinal Tract in Cats. Animals (Basel) 2023; 13:2670. [PMID: 37627461 PMCID: PMC10451872 DOI: 10.3390/ani13162670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
In cats, the gastrointestinal tract is one of the regions in which surgical procedures are most frequently performed by veterinary surgeons; therefore, knowledge of the surgical anatomy of the feline gastrointestinal tract is of high importance. The main surgical procedures performed include gastrotomy, gastrectomy, enterotomy, and enterectomy, as well as procedures in the liver and pancreas. There are also anatomical differences between dogs and cats, increasing the need for deep knowledge of the anatomy treated in the different surgical approaches. The aim of the present review is to describe in detail the anatomy of the gastrointestinal tract in cats highlighting the anatomical regions of significant importance in different surgical procedures.
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Affiliation(s)
- Vasileia Angelou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (V.A.); (L.G.P.)
| | - Aliki Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece;
| | - Michael Patsikas
- Laboratory of Diagnostic Imaging, Department of Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (V.A.); (L.G.P.)
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3
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Pavone G, Castellucci B, Pavone S, Stefanetti V, Vitolo C, Mangiaterra S. Unusual Case of Biliary Peritonitis in a Dog Secondary to a Gastric Perforation. Vet Sci 2023; 10:384. [PMID: 37368770 DOI: 10.3390/vetsci10060384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Biliary peritonitis is a pathological condition representing a medical emergency with a high risk of mortality. This condition is reported in both human and veterinary medicine following biliary tract rupture, extrahepatic biliary obstructions, gallbladder rupture, trauma, or duodenal perforation. In this report, the first-ever case of biliary peritonitis due to gastric perforation in a Bobtail purebred dog is described, which was probably induced by the administration of nonsteroidal anti-inflammatory drugs (NSAIDs). After an elective splenectomy and castration, the dog was referred to our hospital for medical management for inappetence, mental depression, and multiple episodes of gastric vomits with traces of blood. Clinical diagnostic tests showed the presence of biliary peritonitis. Due to worsening clinical conditions, the patient was subjected to euthanasia. Macroscopic examination showed a free brownish abdominal effusion and the presence of perforating ulcer of the stomach pylorus region.
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Affiliation(s)
- Giovanni Pavone
- Futuravet Veterinary Referral Center, 62029 Tolentino, Italy
| | | | - Silvia Pavone
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche 'Togo Rosati', Via G. Salvemini, 1, 06126 Perugia, Italy
| | | | - Chiara Vitolo
- Futuravet Veterinary Referral Center, 62029 Tolentino, Italy
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Barandun MA, Mullins RA, Rytz U. Billroth II procedure for the treatment of spontaneous gastrointestinal perforation in two cats. J Am Vet Med Assoc 2021; 259:1325-1331. [PMID: 34727055 DOI: 10.2460/javma.20.04.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 9-year-old castrated male domestic shorthair cat (cat 1) and a 10-year-old castrated male Maine Coon cat (cat 2) were presented for recurrent feline lower urinary tract disease after receiving outpatient care from their primary veterinarians. CLINICAL FINDINGS Physical examination findings for both cats were initially within reference limits. After a short period of hospitalization, both cats developed peritoneal effusion; results of cytologic analysis of a sample of the fluid were consistent with septic peritonitis. During exploratory laparotomy, perforation of the pylorus or proximal portion of the duodenum secondary to ulceration was identified. TREATMENT AND OUTCOME Both cats underwent partial duodenectomy, partial gastrectomy (pylorectomy), and gastrojejunostomy (Billroth II procedure). The cats recovered from surgery and returned to a normal quality of life; however, each had mild episodes of anorexia but maintained a stable body weight. Cat 2 required additional surgery for trichobezoar removal 7 weeks later but recovered quickly. At 7 months after trichobezoar removal, cat 2 developed intermittent vomiting, but clinicopathologic, abdominal ultrasonographic, and upper gastrointestinal tract endoscopic findings were within reference limits. At 9 (cat 2) and 13 (cat 1) months after the Billroth II procedure, both cats were reported to be in good general health and without gastrointestinal signs. CLINICAL RELEVANCE In both cats, the Billroth II procedure was technically straightforward and associated with a full recovery and good medium- to long-term quality of life. A Billroth II procedure could be considered for treatment of cats with large mural lesions in the pyloroduodenal region.
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Nasry WHS, Martin CK. Intersecting Mechanisms of Hypoxia and Prostaglandin E2-Mediated Inflammation in the Comparative Biology of Oral Squamous Cell Carcinoma. Front Oncol 2021; 11:539361. [PMID: 34094895 PMCID: PMC8175905 DOI: 10.3389/fonc.2021.539361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
The importance of inflammation in the pathogenesis of cancer was first proposed by Rudolph Virchow over 150 years ago, and our understanding of its significance has grown over decades of biomedical research. The arachidonic acid pathway of inflammation, including cyclooxygenase (COX) enzymes, PGE2 synthase enzymes, prostaglandin E2 (PGE2) and PGE2 receptors has been extensively studied and has been associated with different diseases and different types of cancers, including oral squamous cell carcinoma (OSCC). In addition to inflammation in the tumour microenvironment, low oxygen levels (hypoxia) within tumours have also been shown to contribute to tumour progression. Understandably, most of our OSCC knowledge comes from study of this aggressive cancer in human patients and in experimental rodent models. However, domestic animals develop OSCC spontaneously and this is an important, and difficult to treat, form of cancer in veterinary medicine. The primary goal of this review article is to explore the available evidence regarding interaction between hypoxia and the arachidonic acid pathway of inflammation during malignant behaviour of OSCC. Overlapping mechanisms in hypoxia and inflammation can contribute to tumour growth, angiogenesis, and, importantly, resistance to therapy. The benefits and controversies of anti-inflammatory and anti-angiogenic therapies for human and animal OSCC patients will be discussed, including conventional pharmaceutical agents as well as natural products.
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Affiliation(s)
- Walaa Hamed Shaker Nasry
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Chelsea K Martin
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
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6
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Cook S, Greensmith T. Supporting the intoxicated patient: toxicants affecting the gastrointestinal and hepatobiliary systems. IN PRACTICE 2020. [DOI: 10.1136/inp.m3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mate de Haro L, Moreno‐Aguado B, Martí J, Kelly D. Spontaneous gastric rupture presenting as severe pneumoperitoneum in a cat with presumed idiopathic gastric ulceration. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Luis Mate de Haro
- Medicine ServiceSouthern Counties Veterinary SpecialistsRingwoodHampshireUK
| | | | - Juan Martí
- Department of SurgerySouthern Counties Veterinary SpecialistsRingwoodHampshireUK
| | - Darren Kelly
- Medicine ServiceSouthern Counties Veterinary SpecialistsRingwoodHampshireUK
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Yi EM, Leech E. Topical flurbiprofen toxicosis in a cat. J Vet Emerg Crit Care (San Antonio) 2017; 27:707-712. [DOI: 10.1111/vec.12638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/26/2015] [Accepted: 12/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth M. Yi
- VCA Emergency Animal Hospital and Referral Center; San Diego CA 92108
| | - Elizabeth Leech
- VCA Emergency Animal Hospital and Referral Center; San Diego CA 92108
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Daure E, Ross L, Webster CRL. Gastroduodenal Ulceration in Small Animals: Part 1. Pathophysiology and Epidemiology. J Am Anim Hosp Assoc 2017; 53:1-10. [DOI: 10.5326/jaaha-ms-6635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Gastroduodenal ulceration in small animals is a complex and important comorbidity that occurs when the physiological homeostasis of the gastrointestinal tract is disrupted secondary to administration of medications or the presence of local or systemic diseases. The aim of this article is to provide a comprehensive review of the veterinary literature regarding the pathophysiology, epidemiology, and risk factors associated with gastroduodenal ulceration in small animals. Pertinent concepts from the human literature will be integrated into the discussion. This article serves as an introduction to the second part of this series, which will review current evidence regarding the use of H2-receptor antagonists and proton pump inhibitors in small animals.
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Affiliation(s)
- Evence Daure
- From the Centre Vétérinaire Daubigny, Quebec, Canada (E.D.); and the Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts (L.R., C.R.L.W.)
| | - Linda Ross
- From the Centre Vétérinaire Daubigny, Quebec, Canada (E.D.); and the Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts (L.R., C.R.L.W.)
| | - Cynthia R. L. Webster
- From the Centre Vétérinaire Daubigny, Quebec, Canada (E.D.); and the Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts (L.R., C.R.L.W.)
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Bernardin F, Martinez Rivera L, Ragetly G, Gomes E, Hernandez J. Spontaneous gastrointestinal perforation in cats: a retrospective study of 13 cases. J Feline Med Surg 2015; 17:873-9. [PMID: 25406178 PMCID: PMC11112198 DOI: 10.1177/1098612x14558894] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVES The aim of this study was to describe the clinical characteristics and the frequency of malignant vs non-malignant causes for spontaneous gastrointestinal perforation in cats. METHODS The medical records of cats diagnosed as having gastrointestinal perforation between August 2010 and July 2013 were reviewed. Diagnosis was confirmed by exploratory surgery. Patients with incomplete records, perforation due to external trauma, leakage at previous enterotomy or anastomotic sites, or foreign bodies were excluded. Each record was examined for different information pertaining to signalment, medical history, clinical and clinicopathological data, imaging findings, abdominal fluid examination, surgical findings, histopathological examination, treatment received after surgery and outcome. RESULTS Thirteen cats were included. Five of these cats had concurrent illnesses, including viral upper respiratory tract disease, pancreatitis and chronic kidney disease. Two cats had previously received non-steroidal anti-inflammatory drugs and four had received corticosteroids. Clinical signs and clinicopathological abnormalities were not specific. Six of 13 patients were diagnosed during surgery with gastric perforations, four patients with duodenal perforations and three patients with jejunal perforations. Histopathological examination of the ulcerated wall was performed in 11/13 cats. Alimentary lymphoma was diagnosed in six cats. Non-neoplastic lesions (lymphocytic- plasmacytic inflammatory bowel disease, necrotic suppurative enteritis) were observed in the other five cats. The major limitation of the study was the small sample size. CONCLUSIONS AND RELEVANCE Lymphoma may be a frequent cause of spontaneous perforation in cats. Therefore, histological examination of ulceration is essential in all cases. The direct and sole implication of anti-inflammatory administration in a gastrointestinal perforation is not clearly established in this study.
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Affiliation(s)
- Fanny Bernardin
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France
| | - Laura Martinez Rivera
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France
| | - Guillaume Ragetly
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France
| | - Eymeric Gomes
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France
| | - Juan Hernandez
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Arcueil, France
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11
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Šutalo S, Ruetten M, Hartnack S, Reusch CE, Kook PH. The effect of orally administered ranitidine and once-daily or twice-daily orally administered omeprazole on intragastric pH in cats. J Vet Intern Med 2015; 29:840-6. [PMID: 25966746 PMCID: PMC4895399 DOI: 10.1111/jvim.12580] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/12/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gastric acid suppressants frequently are used in cats with acid-related gastric disorders. However, it is not known if these drugs effectively increase intragastric pH in cats. OBJECTIVES To examine the effects of PO administered ranitidine and omeprazole on intragastric pH in cats and to compare the efficacy of once-daily versus twice-daily dosage regimens for omeprazole. ANIMALS Eight domestic shorthair cats. METHODS Using a randomized 4-way cross-over design, cats were given enteric-coated omeprazole granules (1.1-1.3 mg/kg q24h and q12h), ranitidine (1.5-2.3 mg/kg q12h), and placebo. Intragastric pH was monitored continuously for 96 hours using the Bravo(™) system, starting on day 4 of treatment, followed by a median washout period of 12 days. Mean percentage of time pH was ≥3 and ≥4 was compared among groups using repeated measures ANOVA. RESULTS Mean ± SD percentage of time intragastric pH was ≥3 and ≥4 was 67.0 ± 24.0% and 54.6 ± 26.4% for twice-daily omeprazole, 24.4 ± 22.8% and 16.8 ± 19.3% for once-daily omeprazole, 16.5 ± 9.0% and 9.6 ± 5.9% for ranitidine, and 9.4 ± 8.0% and 7.0 ± 6.6% for placebo administration. Twice-daily omeprazole treatment significantly increased intragastric pH, whereas pH after once-daily omeprazole and ranitidine treatments did not differ from that of placebo-treated cats. CONCLUSION AND CLINICAL IMPORTANCE Only twice-daily PO administered omeprazole significantly suppressed gastric acidity in healthy cats, whereas once-daily omeprazole and standard dosages of ranitidine were not effective acid suppressants in cats.
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Affiliation(s)
- S Šutalo
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M Ruetten
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - S Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - P H Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Dayer T, Howard J, Spreng D. Septic peritonitis from pyloric and non-pyloric gastrointestinal perforation: prognostic factors in 44 dogs and 11 cats. J Small Anim Pract 2013; 54:625-9. [DOI: 10.1111/jsap.12151] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Dayer
- Department of Small Animal Surgery, Vetsuisse Faculty; University of Bern; Bern Switzerland
| | - J. Howard
- Department of Clinical Pathology, Vetsuisse Faculty; University of Bern; Bern Switzerland
| | - D. Spreng
- Department of Small Animal Surgery, Vetsuisse Faculty; University of Bern; Bern Switzerland
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13
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Benito J, Hansen B, DePuy V, Davidson G, Thomson A, Simpson W, Roe S, Hardie E, Lascelles B. Feline Musculoskeletal Pain Index: Responsiveness and Testing of Criterion Validity. J Vet Intern Med 2013; 27:474-82. [DOI: 10.1111/jvim.12077] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/28/2013] [Accepted: 02/12/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- J. Benito
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - B. Hansen
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - V. DePuy
- Bowden Statistical Consulting; Oxford NC
| | - G.S. Davidson
- Clinical Pharmacy Services; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - A. Thomson
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - W. Simpson
- Morrisville Cat Hospital; Morrisville NC
| | - S. Roe
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - E. Hardie
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - B.D.X. Lascelles
- Comparative Pain Research Laboratory; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
- Department of Clinical Sciences; Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; Raleigh NC
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Digestive System, Liver, and Abdominal Cavity. THE CAT 2012. [PMCID: PMC7158306 DOI: 10.1016/b978-1-4377-0660-4.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sparkes AH, Heiene R, Lascelles BDX, Malik R, Sampietro LR, Robertson S, Scherk M, Taylor P. ISFM and AAFP consensus guidelines: long-term use of NSAIDs in cats. J Feline Med Surg 2010; 12:521-38. [PMID: 20610311 PMCID: PMC11148988 DOI: 10.1016/j.jfms.2010.05.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED NSAIDS AND CATS: Non-steroidal anti-inflammatory drugs (NSAIDs) are an important class of drug in feline medicine, having analgesic, anti-inflammatory and antipyretic activity. While most published data on their use in this species relate to short-term (often perioperative) therapy, there is increasing evidence of the value of these drugs in treating chronic pain in cats (for example, that associated with degenerative joint disease), and some NSAIDs have now become licensed for long-term use in cats in some geographies. Most of our knowledge of therapeutic mechanisms or adverse drug reactions associated with NSAIDs is extrapolated from work in other species, and there is a paucity of published data relating to cats. GUIDELINES These guidelines have been drawn together by an expert panel, which have reviewed the current literature on long-term NSAID use in cats and other species, and developed guidance on their use based on this information. The aim is to provide practical information for veterinarians to encourage appropriate NSAID therapy whenever cats will benefit from the use of these drugs.
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