[Ellie May]

I think it completely depends on the dog. There is a time and a place for u/s, biopsy, and maybe even Protein C testing. That doesn't mean that they are the best tests available, but they may give the information that is needed. In a dog with HE symptoms and high bile aids, I would go to scintography. However, I'd also have concerns about bladder stones, so I'd probably go with a u/s too if the $$$ was available and we would get added info about the liver. That's not a bad thing. In general, yes I agree, not great at diagnosing shunts, but they have their place. The same goes for biopsy. The assumption is made that if a Yorkie has high bile acids and no shunt, it's probably MVD. But that doesn't mean it couldn't be something else and the treatment could be different. So there is a place for biopsy also. I would not do it in every case that MVD is suspected, but I also can't say it is never worth it.