Carina,
His Bile Acid Test was pre 148 and post 182 - That is HIGH and the chances of him having a Liver Shunt are EXTREMELY HIGH. I would bet he has a Liver Shunt OR a severe case of Microvascular Displasia (MVD). Not ruling out anything else, but you are under Vet care and I am sure you will get him better.
It is good the Vet is going to do a Scintigraphy. You read about that here:
Portal Scintigraphy in Veterinary Medicine Liver Shunt Research
His off-balance and pacing or circling, acting drunk, walking along the walls while his head is off to the side pressing are all Classic symptoms of
Hepatic Encephalopathy (a condition where toxins normally removed by the liver accumulate in the blood and impair the function of brain cells). In order to control the Hepatic Encephalopathy (HE for short), low protein diet such as ROYAL CANIN Veterinary Diet® canine HEPATIC LS™ 14 (Dry Kibble) Hill's L/D (wet/canned), and drugs such as Lactulose AND Antibotics Such as metronidazole are given daily to prevent production and absorption of ammonia and other intestinal toxins.
Lactulose, a disaccharide sugar containing galactose and fructose, is used
for the treatment of hepatic encephalopathy in veterinary medicine. The
active ingredient, lactulose, works by reducing the ammonia build up in the
blood. The large number of resident bacteria in the intestine consumes the
unabsorbed lactose as their food and release lactic, acetic, and formic acid
and carbon dioxide gas. These acids draw fluid into the colon, softening the
stool. The acidification of the bowel contents draws ammonia from the
bloodstream and locks it there to be emitted with the stool. This action
aids the prevention of a form of dementia called hepatic encephalopathy.
HEPATIC LS | Royal Canin Veterinary Diet
Please keep us posted. When is he having the Scintigraphy?