Acute and chronic pancreatitis can present in the emergency or ambulatory setting and be a therapeutic challenge. A thorough history, with laboratory, and imaging workup can help a practitioner understand the etiology of disease and other important features for clinical decision-making. Surgical referral may be a waste of resources in certain circumstances but also the cornerstone of treatment in select pancreatitis pathology. This chapter aims to delineate when surgical referral is appropriate and important.