In establishing a differential diagnosis of abdominal pain, which statement is true?

The statement indicating that the onset of pain before nausea suggests surgical issues is accurate because the pattern of abdominal pain can often provide valuable clues in determining the underlying cause. In cases where an individual experiences severe abdominal pain followed shortly by nausea, it may indicate a gastrointestinal process that is not surgical in nature, such as gastritis or other non-urgent conditions. Conversely, when nausea follows the onset of sharp, severe abdominal pain, it could suggest an acute abdomen, which often requires surgical intervention, such as appendicitis, bowel obstruction, or perforation. This connection helps clinicians prioritize diagnostic evaluations based on the potential for surgical intervention, thereby enhancing patient outcomes.

In the context of the other choices, cervical motion tenderness is typically associated with gynecological issues, not appendicitis. Radiating pain to the scapula is more suggestive of conditions such as cholecystitis or diaphragmatic irritation rather than acute hepatitis. Additionally, diverticulitis tends to cause left lower quadrant pain rather than right upper quadrant pain, aligning with its common presentation.