1.         INTRODUCTION
A.        Wash hands with alcohol gel or water.
B.        Introduce self and seek permission to examine the abdominal system.
C.        Confirm patient’s name and date of birth.
D.        Ask if patient is currently in any pain or discomfort and ask to point to any area of pain.
E.         Position patient supine with one pillow with chest and abdomen adequately exposed.

2.         GENERAL INSPECTION
A         General (discomfort, distension, colour, muscle wasting, scratch marks, spider naevi)
B.        Inspect hands.
C.        Inspect eyes.
D.        Inspect mouth.
E.         Inspect chest and axillae.

3.         INSPECTION OF ABDOMEN
A.         Inspect for movement, distension, scars, herniae, masses, dilated veins and abnormal pulsations.

4.         PALPATION OF ABDOMEN FOR ORGANS AND MASSES
A.        Superficial palpation in each of the 9 regions beginning away from any area of pain.
                   (Palpate for rigidity, tenderness, guarding, rebound and masses whilst observing face.)
B.        Deep palpation
                   Repeat sequence with deeper palpation throughout the 9 regions and assess any masses felt
                   Palpate for liver, spleen, ballot for enlargement of kidneys and palpate abdominal aorta.

5.         PERCUSSION OF ABDOMEN
A.         Percuss for liver.
B.         Percuss for spleen.
C.         Percuss flanks for dullness and demonstrate shifting dullness or fluid thrill if appropriate.

6.         AUSCULTATION
A.        Auscultate for bowel sounds and abdominal aorta bruit.

7.         SIT PATIENT FORWARD
A.        Inspect back.
B.        Palpate for renal tenderness.
C.        Auscultate for renal bruits.
D.        Palpate neck for cervical lymphadenopathy.

8.         OTHER AREAS for completeness, but not expected to be done by preclinical students
A.        Inspect and examine groin for hernias and lymphadenopathy.
B.         Examine external genitalia.
C.         Perform digital rectal examination.
D.         If appropriate palpate and percuss for distended bladder.

9.         CONCLUSION
A.        Look at observation charts and test urine with dipstix.
B.        Thank patient and wash hands with alcohol gel or water.
C.        Summarise and present findings in patient’s notes and orally.