[Ellie May]

That number isn't of major concern. Usually (there are exceptions) when there is an actual liver shunt, the post bile acid number is much higher. The pre number is also usually elevated. Microvascular dysplasia (the link that ladyjane posted) is more likely. It's inoperable and can be medically managed.

A biopsy would show microvascular dysplasia, but not a larger shunt (although the surgeon would likely be able to see it when working with the liver). Ultrasound is fine, but not the most accurate for showing shunts even if one is present. They can show the size of the liver, condition of bladder and kidneys, etc. The more experienced the sonographer, the more likely they will locate a shunt if one is present. There is also the issue of intrahepatic (inside the liver) and extrahepatic (outside the liver) shunting. Extrahepatic are most common in Yorkies and are generally surgical. Intrahepatic are inside the liver and are medically managed. There is also the scintography that will show with fairly good accuracy if a shunt is present. The very best thing you can do is consult with a board certified internal medicine specialist with a lot of experience in this area. They will go over all of this with you and lead you to the best decision for your pup.

All the above aside and even though the bile acids are not terrible elevated, this pup did have neuro symptoms and you should immediately go to a specialist.