The abdominal examination is inspection, then light palpation away from the pain, then deep palpation, then the organs in order of liver, spleen and kidneys, then percussion for ascites and auscultation for bowel sounds and bruits. Expose from the nipples to the knees with the genitalia covered, and kneel so the abdomen is at eye level.

Key takeaways

  • Position the patient flat on one pillow with the arms by the sides, exposing from nipples to knees with the genitalia covered.
  • Watch the patient's face throughout palpation, not your own hands.
  • Palpate for the liver and spleen starting in the right iliac fossa and moving towards the costal margin on inspiration.
  • Shifting dullness is the bedside test for ascites, not sucking the abdomen in.
  • Complete by offering external genitalia, hernial orifices, a rectal examination and a urine dipstick.

How is this station marked in MRCS Part B?

A physical examination station is marked out of 20 across four domains: clinical and technical skill carries 8 marks, and clinical knowledge and its application, communication, and professionalism carry 4 marks each. The examiner also gives the station a separate global rating of pass, borderline or fail.

Two things follow from that split. More than half the marks sit outside your knowledge of the condition, so a silent, technically correct examination scores poorly. And you are signalled at six minutes of the nine to present your findings, so the sequence has to finish inside six.

How do I start the abdominal examination?

Gel your hands in view of the examiners, introduce yourself, explain and gain consent, and check the patient can lie flat. Lower the bed and position them with one pillow and the arms relaxed at the sides.

  • Scan the bedside for drains, stoma bags, catheters, feeding tubes and fluid balance charts.
  • Look at the hands and face for the stigmata of chronic liver disease: clubbing, leuconychia, palmar erythema, Dupuytren's contracture, spider naevi, jaundice and anaemia.
  • Test for asterixis by asking the patient to hold the arms out with the wrists cocked back.

What am I looking for on inspection of the abdomen?

Squat or kneel to the patient's right so the abdominal wall is at eye level, and look before you touch.

  • Distension, asymmetry and visible masses or peristalsis.
  • Scars, and ask the patient what each one is from rather than guessing.
  • Stomas, drains and fistulae, following the tubing to see what is draining.
  • Dilated veins, striae, and the hernial orifices and umbilicus.
  • Ask the patient to lift the head off the pillow and to cough, which brings out incisional hernias and divarication of the recti.

How do I palpate the abdomen?

Ask where the pain is and start furthest from it. Palpate all nine regions lightly, watching the face, then repeat more deeply.

**Guarding** is involuntary tensing of the abdominal wall on palpation and suggests peritoneal irritation. Describe any mass by site, size, shape, surface, consistency, mobility, whether it is pulsatile and whether it moves with respiration.

How do I examine the liver, spleen and kidneys?

  • Liver: start in the right iliac fossa with the radial border of the index finger, ask the patient to breathe in and out, and move upwards a few centimetres with each breath until you reach the costal margin. Percuss the upper and lower borders to measure the span.
  • Spleen: start again in the right iliac fossa and move towards the left costal margin, because the spleen enlarges inferomedially. If you feel nothing, roll the patient towards you into the right lateral position and repeat.
  • Kidneys: ballot each kidney with one hand in the loin and the other at the costal margin, pushing upwards with the lower hand.

Stanford Medicine 25 makes the key technical point on the spleen: stay still and let the spleen come down onto your fingers on inspiration rather than digging for it.

How do I test for ascites?

Percuss from the midline out towards the flank until the note becomes dull, keep your fingers in place, then roll the patient away from you and wait a few seconds. If the note at that point becomes resonant, the dullness has shifted and there is free fluid.

A fluid thrill is the alternative. Ask the patient or the examiner to press the edge of a hand down the midline, flick one flank and feel for the transmitted thrill on the other.

What do I listen for, and how do I finish?

  • Bowel sounds for at least 15 to 20 seconds before calling them absent.
  • Aortic bruits a few centimetres above the umbilicus, and renal bruits at the lateral border of the rectus muscle.
  • Palpate for an abdominal aortic aneurysm with a hand either side of the midline above the umbilicus.
  • Feel the inguinal regions and ask the patient to cough, and palpate for lymphadenopathy.
  • Say aloud that you would examine the external genitalia, perform a rectal examination and dipstick the urine.

What is the examiner marking, and what goes wrong?

The abdominal station is marked out of 20 with a global rating of pass, borderline or fail, across the Intercollegiate domains of clinical knowledge, clinical and technical skill, communication and professionalism.

  • Palpating without watching the patient's face, which loses professionalism marks and misses tenderness.
  • Starting deep palpation immediately, which makes the rest of the examination impossible.
  • Beginning the liver or spleen at the costal margin and missing gross organomegaly.
  • Guessing what a scar is instead of asking.
  • Forgetting to offer the rectal examination and external genitalia.

MRCS Part B Questions has an abdominal examination station with a marked checklist at /Sample-Questions. Reviewed and updated 15 September 2026.