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Originally Posted by Oscar's Mummy 
I was under the impression that such high BAT results kind of ruled out MVD? I thought MVD generally gave results of 100 or lower?
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First of all, I am sorry to read that your baby has liver problems...But remember that this is not a death sentence by any means. My yorkie was diagnosed when he was a pup, and here he is at 4 yrs old doing great!! He lives a normal life. The only differences between him and my healthy maltese are that he can't have meat protein like her, he eats 6 times a day to lighten the load on his liver (because he is very symptomatic if not cared for properly) and he has extra things added to his food.
Typically, results under 100 point towards MVD, but I know of several dogs, including my own whose numbers were beyond 300 and they have MVD, not an extrahepatic shunt. Those are only guidelines, they are not numbers that are set in stone.
The next step, in my opinion, would be the protein C test, or if your budget allows, the scintigraphy. This should be done to help determine if there is an extrahepatic shunt. If there is an extrahepatic shunt, surgery is the best option, but the older the dog is, the more dangerous it is to close off the shunt because there are increased risks. I do know of dogs over the age or 2 who have had the surgery done, and they came out okay. Ameroid constrictor should be used.
If the protein C test and scintigraphy point towards MVD, the only way to confirm this is through a biopsy of the liver. This, of course, requires surgery though. If it's likely to be MVD, then you could opt *not* to put her through surgery, since the medical management aspect would be the same regardless.
You are correct about the K/D. This is not a food that should be given to liver compromised dogs because it contains liver and makes the liver work too hard. It produces a lot of ammonia that the liver has trouble filtering.
Please ask your vet for canned L/D or Royal Canin Hepatic LS 14.
You say she is on metronidazole. Do you know if they intend to use it long-term or just for 7-14 days? If they want her on it long-term, then she should be getting a low-dose of it.
The lactulose is important. Your dog should be having 2 soft stools per day. The lactulose dosage should be broken up into 3x per day and the amount should be adjusted so that she has 2 soft stools per day.