This sort of thing sometimes isn't caught in routine blood work because usually the liver has to be considerably damaged for the enzymes to go up. This is why all Yorkies should be bile acids tested after 20 weeks of age.
Some dogs live their whole lives without anybody ever realizing MVD is present. They are just asymptomatic. There was one dog that I know of that had LS and wasn't diagnosed until age 8.
While it is likely MVD, high bile acids don't always mean that. Anything that affects liver function can show up as high bile acids. An ultrasound is good to see the size of the liver and to rule out bladder stones secondary to liver disease but it is not the most accurate test to rule out a shunt.
I would at least do a Protein C test in addition to the U/S if the vet is insisting on the U/S.
Since he is symtpomatic and his bile acids are high, I would feed no red meat, organ meat or exotics for now.
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