Acute pancreatitis (AP) can be very severe and the current review updates the knowledge on severity scoring to identify AP. In particular, the place of the «old» specific scoring system versus the scoring used routinely in intensive care medicine is reviewed. As infectious complications of AP worsen the prognosis, large spectrum antibiotics are often administrated. Literature review demonstrates that such therapeutical attitude is not justified by evidence-based medicine. Finally the nutrition during an AP episode is reviewed and a special emphasis is presented on the need for enteral nutrition.