Dog with anorexia, lethargy, and vomiting

History of Present Illness

A 4-year-old female, spayed Yorkshire terrier dog is brought to the clinic by his owner for further evaluation. The dog has been anorectic, lethargic, and vomiting for several days. During a visit to the referring veterinarian2 months ago, blood work revealed increased liver enzymes. The dog was started on amoxicillin and a liver support supplement but did not improve. Repeat blood work 1 month later showed a further increase in liver enzymes, and the client was referred for further evaluation.