Latent ascites

Latent ascites (< 250 ml) can be determined by sonography. Detection of fluid in the abdominal cavity signals decompensation of cirrhosis and the corresponding inefficacy of prophylactic measures. Medication is recommended as part of a stepwise therapy. To start with, the prophylactic measures for ascites should be applied more intensively and consistently. Both ascites itself and its treatment harbour risks for the patient. 

Documentation sheet Presentation of the documentation sheet by the patient containing details of body weight and handwriting specimens during the respective follow-up phase. This form (which can easily be drawn up by the patient) may contain, on the front and back, daily entries for 2 follow-up months. This patient-made documentation is the cheapest and most reliable followup method with regard to early detection of the two most sensitive signs of decompensation latent HE and latent ascites, (s. fig. 15.3) (s. pp 275, 305)... 

In pathophysiological and prognostic terms, even ascites that can only be identified by ultrasonic methods is a sign of decompensation - either decompensation which is still latent, yet unstable, or decompensation which is slowly increasing by itself This latter condition ultimately calls for much more severe measures (also involving more side effects) than merely moderate and cautious efforts to restore the patient to a stable state of recompensation, which should then be as lasting as possible. 

Impairment of cerebral functions and disturbances of the water and electrolyte balance are the two most important and most common manifestations of decompensated liver cirrhosis. They may be reliably detected at an early stage by means of daily body weight control and simple psychometric tests. A documentation sheet filled in by the patient has proved to be worthwhile latent oedemas or the onset of ascites as well as latent encephalopathy can be detected in this way and thus treated at an early stage. Longterm standing leads to a reduction of natriuresis with subsequent water retention and a deterioration of renal blood flow (like a vicious circle). This is caused by activation of the RAAS and the sympathetic nervous system. Such a dangerous situation (which can arise for example after two hours of standing at a sports event with excessive emotional participation) is often underrated, as we ourselves observed in several patients (s. p. 292) (s. fig. 15.3) (see chapter 16 )... 

Ascites The oeeurrence of a disturbed water-eleetrolyte balance in the late stage of latent oedema (s. fig. 15.3) (s. p. 297) requires immediate restriction of the salt intake (<3-6 g/day) - depending on the level of natriuresis the intake of fluid is limited to 1.0 (-1.5) 1/day especially in hyponatriaemia. An intermittent fruit and rice diet (generally for 1-2 days) is recommended because it is extremely low in sodium, but rich in potassium. Marked NaCl restriction simultaneously leads to a reduction in protein intake. The use of commercially available low-salt protein preparations is therefore advisable (e.g. 60 g protein/100 g + 5 mval sodium/100 g, or 48 g protein/100 g + 13 g, or 15 g sodium/100 g). 

---