Does the presence of ascites in cirrhosis always indicate the patient is in a decompensated state?

Not exactly: It indicates the severity of disease process, but can be created at variable rate (/volume) depending on compliance w/meds and diet (salt excess a big one). True decompensation usually w/ascites and jaundice (yellow appearance to skin / sclera).

No necessarily: In patients with underlying liver disease, the presence of ascites is not favorable, but may be due to several things including sodium intake, degree of portal hypertension, stress (infection, other medical problems). We will start with diuretic medications to help the liver process fluid better. Try a low salt diet. Nutritionists can often help.