The results of the study of the structural changes of pancreas, lipid metabolism and systemic inflammatory response considering the etiological factor and gender of patients with acute pancreatitis and exacerbation of chronic pancreatitis are presented in the article. It was estimated, that acute biliary pancreatitis is accompanied by a stronger systemic inflammatory response according to the level of C-reactive protein (p=0.027) and significant dyslipidemic disorders. The structural changes of the pancreas during acute alcoholic pancreatitis are characterized by a moderate inflammatory reaction of the parenchyma, parapancreatic hydrophily and the appearance of small cysts. Biliary acute pancreatitis is associated with a greater frequency of acute inflammatory changes of the pancreas structure: the decrease in echogenicity and its heterogeneity. Thus, there are differences in the degree of severity and structural changes of pancreas, depending on etiological factors, within the context of dyslipidemic disorders and systemic inflammatory response of acute pancreatitis or exacerbation of chronic pancreatitis.