This publication presents new and fascinating insights especially into the pathogenesis of both acute and chronic pancreatitis. It starts with a literature review and presentation of the authors' own data on laboratory markers of acute pancreatitis such as trypsinogen, serum amyloid A and procalcitonin, paying special attention to their clinical usefulness and test performance for stratifying severity and monitoring disease progression. Also discussed is the still difficult differential diagnosis between pancreatic cancer and chronic pancreatitis, especially the early diagnosis of pancreatic cancer in preexisting chronic pancreatitis: particularly, the high specificity of molecular alterations in pancreatic cancer - as found in some pilot studies - has the potential of a strong complementary marker of malignancy in patients with a pancreatic mass of uncertain origin. Further topics discussed are acute-phase reactions during early pancreatic cellular injury, tropic pancreatitis, and more.