Well, the 242 could be much worse, but that does suggest that diagnostics need to be done.
Since the enzymes were perfectly normal three years ago, could be have gotten into anything toxic since then? Gum with xylitol or certain plants come to mind.
The liver is pretty forgiving. Try to stay calm. Yes, the bile acids test is indicated. I'm not going to say you should skip the xray although if they are going to send you for a U/S anyway, it is possible that the vet will be okay holding off on that.
Zentonil is SAMe, I think. Denosyl is a bit more popular and would accomplish the same thing. Wouldn't hurt to use that instead if the vet okays it. They just may carry the Zentonil there... In this situation, I would definitely go with the vet's recommendation to use SAMe. It helps prevent liver cell death (which is very likely happening with an ALT over double what it should be).
I'd be very, very surprised if a high protein diet made the ALT go up that much. What flea preventative do you use, if any? Some drugs can make it go up.
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