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Originally Posted by bchgirl  What was the results on the bile acid test? The next step should be a protein c test...sometimes shunts aren't detectable on an ultrasound. |
Ultrasounds are not recommended anymore, scintigraphy is. Ultrasounds can be as low as 60% reliable.
The next step is a protein C test, before imaging.
Recent studies indicate that protein C deficiency is a marker of liver disease in dogs. Protein C deficiency develops in dogs with hepatic synthetic failure and in portosystemic shunting disorders.
The protein C activity assay is especially useful as a non-invasive measure of portal blood flow. Dogs with congenital portosystemic vascular anomalies (PSVA) typically have low protein C activity, with values < 70% of normal. Although clinical signs and chemistry profiles of dogs with PSVA and microvascular dysplasia are similar, the finding of low protein C activity supports a diagnosis of PSVA. Furthermore, protein C activities can be monitored after shunt ligation to assess restoration of portal blood flow.
This link explains the protein C test.
Comparative Coagulation -- NYS Animal Health Diagnostic Center
A lot of research has been done on liver disease in the past few years and most vets just aren't aware of the advances and changes in protocol. You can waste a lot of time and money getting the wrong tests done and end up with no conclusive answers.