As a novice or an expert (Benner, 1985), abdominal presentations can be intriguing and puzzling. It is vital to take a good patient history and conduct a systematic physical assessment, and to think about immediate management (this might be simple pain management or helping with moving bowels) and to consider the longer term — changes to the signs and symptoms, not resolving despite treatment or good management, weight loss or bleeding. Always heed the patient’s intuition — and yours. Monitoring the abdominal problem, the patient keeping a diary if symptoms are sporadic, and giving worsening care advice are as much a part of treatment as medications and investigations. Low thresholds for review include the above but should also be considered in vulnerable populations such as the very young and very old who can deteriorate quickly, and those with pre-existing and long-term conditions, e.g. malignancy and being immunocompromised.This article should be used as an adjunct to an accredited theoretical course with a completed and successful competency assessment.