Two weeks prior to coming to OSU, Murphy had an episode of ataxia, weakness, disorientation, pacing, drooling, and falling over. She also had intermittent vomiting and diarrhea. Murphy was taken to the RDVM who performed a CBC and profile. Significant findings included a decreased MCV (57) and decreased total protein (5.3 gm/dl). An abdominal radiograph suggested a small liver. Fasting and 2 hour post-prandial serum bile acids were 262 umol/L (N<10) and 338 umol/L (N<15). Murphy improved after treatment with amoxicillin and a restricted protein diet. She was referred to OSU for further diagnosis.
At this point, you would like to perform a physical exam and
run some diagnostic tests.