Preheat the oven to 355°, In a large mixing bowl, combine the beef, hot sausage(optional) eggs and chopped onions.
Add the bread crumbs, garlic powder, Italian seasoning, Worcestershire sauce, salt, and pepper
Mix everything together with your clean hands.
Transfer in a loaf pan. Pack it real tight.
Brush 1/2 cup of ketchup on top. Save the remaining 1/2 cup for later.
Bake it in the oven for 45 minutes. Take the pan out then brush the remaining ketchup on top. Place it back into the oven to cook for 15 more minutes.