Acute pancreatitis is an acute inflammation of the exocrine part of the pancreas and is considered a frequent and serious disease. Etiologically, it is most often caused by gallstones or excessive alcohol consumption. The most accepted theory of acute pancreatitis pathogenesis is based on the activation of trypsin in the pancreas caused by various disease agents. Activated trypsin in turn activates the rest of the enzymes, thus triggering the breakdown of pancreatic tissue and the development of inflammation. Excessive calcium accumulation is crucial in the developing stages of acute pancreatitis. As a result, the mitochondrial membranes are damaged, and their ability to produce ATP is reduced. Consequently, acinar cells become damaged and start dying of apoptosis or necrosis. The transcription factor NFkappB plays a vital role in regulating the severity and strength of the immune response to acute pancreatic inflammation and its course. Dysregulated autophagy contributes to the development of acute pancreatitis. Endoplasmic reticulum stress has been found to induce a UPR response that aims to protect the acinar cell. If the stress is too high, the UPR activates the NFkappaB inflammatory pathway, which causes acinar cells to necrotize and stimulates pancreatic inflammation. Exosomes as factors in the pathogenesis of acute pancreatitis are able to regulate inflammation and its impact on distant organs, and it is believed that, in the future, it will be possible to use them as biomarkers in the process of diagnosing and assessing the severity and course of acute pancreatitis. The pathophysiology of acute pancreatitis starts from a state of pancreatic acinar cell damage and continues with local inflammation of the pancreas which turns systemic and can lead to SIRS or MODS. The most severe stage of the disease, which may or may not develop, is the one in which pancreatic necrosis occurs. A patient with acute pancreatitis needs to be approached in a serious manner. Laboratory testing to determine the concentration of serum lipases and amylases is necessary, as well as administering treatment in accordance with the latest guidelines.